Provider Demographics
NPI:1568490811
Name:BAQUET, GLEN MARTIN (AUD)
Entity Type:Individual
Prefix:DR
First Name:GLEN
Middle Name:MARTIN
Last Name:BAQUET
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8830 DOLLYHYDE RD
Mailing Address - Street 2:
Mailing Address - City:UNION BRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21791-7624
Mailing Address - Country:US
Mailing Address - Phone:301-898-3395
Mailing Address - Fax:
Practice Address - Street 1:10 N. GREENE ST.
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:401-605-7000
Practice Address - Fax:410-605-7702
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00917231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist