Provider Demographics
NPI:1942249370
Name:BAER, SIDERIS DAVID (MD)
Entity Type:Individual
Prefix:
First Name:SIDERIS
Middle Name:DAVID
Last Name:BAER
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 2190
Mailing Address - Street 2:
Mailing Address - City:WEST PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-7190
Mailing Address - Country:US
Mailing Address - Phone:781-231-7026
Mailing Address - Fax:
Practice Address - Street 1:92 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:IPSWICH
Practice Address - State:MA
Practice Address - Zip Code:01938-1902
Practice Address - Country:US
Practice Address - Phone:978-356-4884
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA42200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAD12024OtherBLUE CROSS/BLUE SHIELD
MA0470039OtherUSHC
MA32031OtherFALLON HEALTHCARE
MA0152366Medicaid
MA62251OtherHARVARD PILGRIM HEALTH CA
MA713595OtherTUFTS HEALTH CARE
MA0152366Medicaid
D12024Medicare ID - Type Unspecified