Provider Demographics
NPI:1780642090
Name:BAFFOE-BONNIE, GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:BAFFOE-BONNIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-2882
Mailing Address - Fax:410-328-7607
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-2882
Practice Address - Fax:410-328-7607
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD59190208M00000X
VA0101249762208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000038472Medicaid
MD616305-01OtherBLUE CROSS/BLUE SHIELD
MD400053600Medicaid
MD110239327Medicare PIN
VAVV2536AMedicare PIN
MD616305-01OtherBLUE CROSS/BLUE SHIELD
MDH70164Medicare UPIN