=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376546648
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YOUNG C. BAE, M.D.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 900 SETON DR
-----------------------------------------------------
City | CUMBERLAND
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21502-1854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-724-8727
-----------------------------------------------------
Fax | 301-724-7429
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 698
-----------------------------------------------------
City | CUMBERLAND
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21501-0698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-724-8727
-----------------------------------------------------
Fax | 301-724-7429
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | M.D.
-----------------------------------------------------
Name | DR. YOUNG C BAE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 301-724-8727
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------