Healthcare Provider Details

I. General information

NPI: 1003895764
Provider Name (Legal Business Name): ILENE B BAYER-GARNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 BERRYWOOD DR
SEVERNA PARK MD
21146-2034
US

IV. Provider business mailing address

285 BERRYWOOD DR
SEVERNA PARK MD
21146-2034
US

V. Phone/Fax

Practice location:
  • Phone: 443-926-4251
  • Fax:
Mailing address:
  • Phone: 443-926-4251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberD0064386
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberD0064386
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code193200000X
TaxonomyMulti-Specialty Group
License Number17922
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: