Provider Demographics
NPI:1841506201
Name:BAY AREA ORTHOPAEDICS & SPORTS MEDICINE
Entity type:Organization
Organization Name:BAY AREA ORTHOPAEDICS & SPORTS MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-768-5050
Mailing Address - Street 1:1630 MAIN ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21619-2791
Mailing Address - Country:US
Mailing Address - Phone:410-643-3410
Mailing Address - Fax:410-643-5938
Practice Address - Street 1:1600 CRAIN HWY S
Practice Address - Street 2:SUITE 401
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5577
Practice Address - Country:US
Practice Address - Phone:410-768-5050
Practice Address - Fax:410-768-5385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD332B00000X, 335E00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD6831OtherBLUE SHIELD OF DC
MDCE3238OtherRAILROAD MEDICARE
MDKE66BAOtherBLUE SHIELD OF MARYLAND
MD408171400Medicaid
MDH343Medicare PIN
MD408171400Medicaid