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NPI Code Detail

MEDICARE: BAO N DANG MD

MEDICARE: BAO N DANG MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianE4971AR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265450654
Entity Type Code : Individual
Provider Name (Legal Business Name) : BAO N DANG MD
Provider Business Mailing Address
First Line : PO BOX 11449
Second Line :
City : BELFAST
State : ME
Zip : 04915-4005
Country : US
Telephone Number : 479-709-1924
Fax Number : 479-709-7499
Provider Business Practice Location Address
First Line : 8600 S 36TH TER
Second Line :
City : FORT SMITH
State : AR
Zip : 72908-8768
Country : US
Telephone Number : 479-709-7473
Fax Number : 479-709-7466
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2006
Last Update Date : 11/23/2016

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Directions to “ BAO N DANG MD” Practice Location

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