Healthcare Provider Details

I. General information

NPI: 1679594022
Provider Name (Legal Business Name): TERRY M BAIRD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 05/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30313 PROVINCETOWN LN
BAY VILLAGE OH
44140-1741
US

IV. Provider business mailing address

30313 PROVINCETOWN LN
BAY VILLAGE OH
44140-1741
US

V. Phone/Fax

Practice location:
  • Phone: 440-250-0572
  • Fax:
Mailing address:
  • Phone: 440-250-0572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number35-055292
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: