Healthcare Provider Details

I. General information

NPI: 1699463778
Provider Name (Legal Business Name): CALEB A BAYEWU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6506 REISTERSTOWN RD
BALTIMORE MD
21215-2304
US

IV. Provider business mailing address

6506 REISTERSTOWN RD
BALTIMORE MD
21215-2304
US

V. Phone/Fax

Practice location:
  • Phone: 410-764-7044
  • Fax:
Mailing address:
  • Phone: 410-764-7044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number01829
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number01829
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number01829
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: