Provider Demographics
NPI:1881840551
Name:STEPHANIE BAIRD
Entity Type:Organization
Organization Name:STEPHANIE BAIRD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:ACUPUNCTURIST
Authorized Official - Phone:207-871-5060
Mailing Address - Street 1:222 SAINT JOHN ST STE 226
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3058
Mailing Address - Country:US
Mailing Address - Phone:207-871-5060
Mailing Address - Fax:207-839-2197
Practice Address - Street 1:222 SAINT JOHN ST STE 226
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3058
Practice Address - Country:US
Practice Address - Phone:207-871-5060
Practice Address - Fax:207-839-2197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC159171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME031098OtherANTHEM