Healthcare Provider Details

I. General information

NPI: 1003826801
Provider Name (Legal Business Name): HEIKE BARBARA BAILIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 RUSSELL AVE SUITE #1
GAITHERSBURG MD
20879-3584
US

IV. Provider business mailing address

803 RUSSELL AVE SUITE #1
GAITHERSBURG MD
20879-3584
US

V. Phone/Fax

Practice location:
  • Phone: 301-869-0700
  • Fax: 301-947-9513
Mailing address:
  • Phone: 301-869-0700
  • Fax: 301-947-9513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0052701
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: