Provider Demographics
NPI:1972509362
Name:COMPREHENSIVE NEUROLOGY AND SLEEP MEDICINE, P.A.
Entity Type:Organization
Organization Name:COMPREHENSIVE NEUROLOGY AND SLEEP MEDICINE, P.A.
Other - Org Name:KONRAD W. BAKKER, M.D., P.A.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHRIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-694-0900
Mailing Address - Street 1:172 THOMAS JOHNSON DR
Mailing Address - Street 2:STE 100
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4405
Mailing Address - Country:US
Mailing Address - Phone:301-694-0900
Mailing Address - Fax:301-694-0657
Practice Address - Street 1:172 THOMAS JOHNSON DR
Practice Address - Street 2:STE 100
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4405
Practice Address - Country:US
Practice Address - Phone:301-694-0900
Practice Address - Fax:301-694-0657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00353222084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA372721OtherMAMSI/MDIPA/OC DME
DC5113OtherBLUE CROSS BLUE SHEILD
MD613465OtherMAMSI/MDIPA/OPT.CHOICE
MDKFE9COOtherBLUE CROSS BLUE SHIELD
MD3327089OtherAETNA HMO
VA3473625OtherATENA HMO
ME372721OtherMAMSI/MDIPA/OC DME
MD4137505OtherAETNA PPO/MC/EPO
MD495169OtherNCPPO
MD526711100Medicaid
MD1306711010OtherCIGNA
VA237074OtherANTHEM HEALTHKEEPERS
MD500310OtherUNITED HEALTHCARE
VA237076OtherANTHEM BC/BS
MD3327089OtherAETNA HMO
VA3473625OtherATENA HMO
MD4137505OtherAETNA PPO/MC/EPO
MD526711100Medicaid
MD424MMedicare PIN