Healthcare Provider Details

I. General information

NPI: 1063972461
Provider Name (Legal Business Name): DANIEL BAQUET MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-0001
US

IV. Provider business mailing address

8830 DOLLYHYDE RD
UNION BRIDGE MD
21791-7624
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-4629
  • Fax:
Mailing address:
  • Phone: 301-667-0389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number94931
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: