Provider Demographics
NPI:1497754550
Name:BAIG, KHADAR (MD)
Entity Type:Individual
Prefix:
First Name:KHADAR
Middle Name:
Last Name:BAIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12070 OLD LINE CTR
Mailing Address - Street 2:STE 200
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2503
Mailing Address - Country:US
Mailing Address - Phone:301-645-8035
Mailing Address - Fax:301-645-5229
Practice Address - Street 1:12070 OLD LINE CTR
Practice Address - Street 2:STE 200
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2503
Practice Address - Country:US
Practice Address - Phone:301-645-8035
Practice Address - Fax:301-645-5229
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0025992207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC035199700Medicaid
MD796891400Medicaid
DC035199700Medicaid
MD774WMedicare PIN
DC007682G22Medicare PIN