Healthcare Provider Details

I. General information

NPI: 1245418607
Provider Name (Legal Business Name): NORTH BAY ORTHOPAEDICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 S UNION AVE SUITE 300
HAVRE DE GRACE MD
21078-3300
US

IV. Provider business mailing address

421 S UNION AVE SUITE 300
HAVRE DE GRACE MD
21078-3300
US

V. Phone/Fax

Practice location:
  • Phone: 410-939-7077
  • Fax: 410-939-7983
Mailing address:
  • Phone: 410-939-7077
  • Fax: 410-939-7983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberD57143
License Number StateMD

VIII. Authorized Official

Name: JENNIFER WATT
Title or Position: OFFICE MANAGER
Credential:
Phone: 410-939-7077