Provider Demographics
NPI:1518212786
Name:PRIME ALLERGY & ASTHMA CARE, LLC
Entity Type:Organization
Organization Name:PRIME ALLERGY & ASTHMA CARE, LLC
Other - Org Name:ROSALYN BAKER, MD MHS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADULT AND PEDIATRIC ALLERGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MHS
Authorized Official - Phone:301-877-4620
Mailing Address - Street 1:PO BOX 26202
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22313-6202
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7501 SURRATTS RD
Practice Address - Street 2:#202
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3362
Practice Address - Country:US
Practice Address - Phone:301-877-4616
Practice Address - Fax:301-877-2695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD58774207KA0200X, 207KI0005X, 207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
No207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory ImmunologyGroup - Multi-Specialty
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Multi-Specialty