Healthcare Provider Details

I. General information

NPI: 1629027271
Provider Name (Legal Business Name): STEPHEN BAAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 05/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 DORSET ST SUITE 1
SOUTH BURLINGTON VT
05403-6212
US

IV. Provider business mailing address

386 DORSET ST SUITE 1
SOUTH BURLINGTON VT
05403-6212
US

V. Phone/Fax

Practice location:
  • Phone: 802-860-1441
  • Fax: 802-860-4646
Mailing address:
  • Phone: 802-860-1441
  • Fax: 802-860-4646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number420010723
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: