Provider Demographics
NPI:1396793857
Name:BAITINGER, JOHN F (PA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:BAITINGER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6007
Mailing Address - Country:US
Mailing Address - Phone:203-792-5558
Mailing Address - Fax:203-731-3213
Practice Address - Street 1:33 HOSPITAL AVENUE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810
Practice Address - Country:US
Practice Address - Phone:203-792-5558
Practice Address - Fax:203-731-3213
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000651363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT290000651CT11OtherANTHEM BLUE CROSS BLUE SHIELD
CT0198860001Medicare NSC
CTC00267Medicare PIN
CT970002694Medicare PIN
CT290000651CT11OtherANTHEM BLUE CROSS BLUE SHIELD