Healthcare Provider Details

I. General information

NPI: 1982000675
Provider Name (Legal Business Name): SOLLAY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2014
Last Update Date: 11/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 LOCH RAVEN BLVD
BALTIMORE MD
21239-2945
US

IV. Provider business mailing address

5601 LOCH RAVEN BLVD
BALTIMORE MD
21239-2945
US

V. Phone/Fax

Practice location:
  • Phone: 410-323-0777
  • Fax: 410-323-0775
Mailing address:
  • Phone: 410-323-0777
  • Fax: 410-323-0775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberD0058570
License Number StateMD

VIII. Authorized Official

Name: DR. TERRANCE LEE BAKER
Title or Position: OWNER
Credential: MD
Phone: 410-323-0777