Provider Demographics
NPI:1538663109
Name:BABY LIST HEALTH, LLC
Entity Type:Organization
Organization Name:BABY LIST HEALTH, LLC
Other - Org Name:SOURCEMD, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT/MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-431-0144
Mailing Address - Street 1:5 RIGGS AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-3879
Mailing Address - Country:US
Mailing Address - Phone:410-431-0144
Mailing Address - Fax:
Practice Address - Street 1:5 RIGGS AVE STE 3
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3879
Practice Address - Country:US
Practice Address - Phone:410-431-0144
Practice Address - Fax:443-218-2064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDBL123OtherMEDICARE