Provider Demographics
NPI:1396761870
Name:BAYDARIAN, KIMBERLY PICCIONE (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:PICCIONE
Last Name:BAYDARIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8507 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4819
Mailing Address - Country:US
Mailing Address - Phone:410-496-6441
Mailing Address - Fax:410-496-6448
Practice Address - Street 1:8507 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-4819
Practice Address - Country:US
Practice Address - Phone:410-496-6441
Practice Address - Fax:410-496-6448
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061684207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD132190100Medicaid
MD406052100Medicaid
MD406052100Medicaid
MD211850Medicare Oscar/Certification
MDK239Medicare PIN
MDI23289Medicare UPIN
MD211819Medicare Oscar/Certification