Provider Demographics
NPI:1689857096
Name:BALTIMORE CENTER FOR FACIAL PLASTIC SURGERY, L.L.C.
Entity Type:Organization
Organization Name:BALTIMORE CENTER FOR FACIAL PLASTIC SURGERY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:BAKER
Authorized Official - Last Name:CAPONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-848-4123
Mailing Address - Street 1:6535 N CHARLES ST
Mailing Address - Street 2:PHYSICIANS PAVILION NORTH
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-5826
Mailing Address - Country:US
Mailing Address - Phone:410-848-4123
Mailing Address - Fax:410-848-4124
Practice Address - Street 1:6535 N CHARLES ST
Practice Address - Street 2:PHYSICIANS PAVILION NORTH
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-5826
Practice Address - Country:US
Practice Address - Phone:410-848-4123
Practice Address - Fax:410-848-4124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0060483207YS0123X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD232PMedicare PIN
MDH66735Medicare UPIN