Provider Demographics
NPI:1982756730
Name:BAZING, IRIS D (MD, MPH)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:D
Last Name:BAZING
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 N WALNUT ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-4738
Mailing Address - Country:US
Mailing Address - Phone:301-745-3777
Mailing Address - Fax:301-393-3434
Practice Address - Street 1:24 N WALNUT ST
Practice Address - Street 2:SUITE 102
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-4738
Practice Address - Country:US
Practice Address - Phone:301-745-3777
Practice Address - Fax:301-393-3434
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
MDD51224207R00000X, 208000000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No171100000XOther Service ProvidersAcupuncturist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD796472200Medicaid