Provider Demographics
NPI:1689979171
Name:BAY AREA ORTHOPAEDICS & SPORTS MEDICINE
Entity Type:Organization
Organization Name:BAY AREA ORTHOPAEDICS & SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-262-6066
Mailing Address - Street 1:1600 CRAIN HWY S
Mailing Address - Street 2:SUITE 401
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5577
Mailing Address - Country:US
Mailing Address - Phone:410-768-5050
Mailing Address - Fax:410-768-7830
Practice Address - Street 1:4201 NORTHVIEW DR
Practice Address - Street 2:SUITE 101
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-2604
Practice Address - Country:US
Practice Address - Phone:301-262-6066
Practice Address - Fax:301-266-7447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD174400000X, 332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
224733Medicare PIN