Provider Demographics
NPI:1942242557
Name:BAAG, DONGHO (MD)
Entity Type:Individual
Prefix:DR
First Name:DONGHO
Middle Name:
Last Name:BAAG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DON
Other - Middle Name:
Other - Last Name:BAAG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:361 BOILER HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:PERRY POINT
Mailing Address - State:MD
Mailing Address - Zip Code:21902-1103
Mailing Address - Country:US
Mailing Address - Phone:410-642-2411
Mailing Address - Fax:410-642-1825
Practice Address - Street 1:9 OKLAHOMA STATE DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-1142
Practice Address - Country:US
Practice Address - Phone:302-584-4853
Practice Address - Fax:302-397-2900
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2015-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10005050207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEH01985Medicare UPIN