Healthcare Provider Details

I. General information

NPI: 1841506201
Provider Name (Legal Business Name): BAY AREA ORTHOPAEDICS & SPORTS MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2010
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CRAIN HWY S SUITE 401
GLEN BURNIE MD
21061-5577
US

IV. Provider business mailing address

1630 MAIN ST SUITE 108
CHESTER MD
21619-2791
US

V. Phone/Fax

Practice location:
  • Phone: 410-768-5050
  • Fax: 410-768-5385
Mailing address:
  • Phone: 410-643-3410
  • Fax: 410-643-5938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateMD

VIII. Authorized Official

Name: DR. STEPHEN D BROWN
Title or Position: PHYSICIAN/OWNER
Credential:
Phone: 410-768-5050