Provider Demographics
NPI:1265577118
Name:HUSNA R BAKSH MD PC
Entity type:Organization
Organization Name:HUSNA R BAKSH MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HUSNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-593-6072
Mailing Address - Street 1:10750 COLUMBIA PIKE STE 401A
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4402
Mailing Address - Country:US
Mailing Address - Phone:301-593-6072
Mailing Address - Fax:
Practice Address - Street 1:10750 COLUMBIA PIKE STE 2401A
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4402
Practice Address - Country:US
Practice Address - Phone:301-593-6072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0043436207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD198561200Medicaid
P00430052Medicare PIN
MDF49014Medicare UPIN
DC484374Medicare PIN