Provider Demographics
NPI:1497471072
Name:BAZEMORE, SIARA
Entity Type:Individual
Prefix:
First Name:SIARA
Middle Name:
Last Name:BAZEMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 SPRINGTIME WAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-8704
Mailing Address - Country:US
Mailing Address - Phone:410-816-4401
Mailing Address - Fax:
Practice Address - Street 1:1301 YORK RD
Practice Address - Street 2:STE 800 LT8
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6011
Practice Address - Country:US
Practice Address - Phone:410-746-5397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other