MEDICARE: YOUNG C. BAE, M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2563YC	OTHER	MD	BLUE SHIELD

General Provider Information

NPI Number	:	1376546648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUNG C. BAE, M.D.

Provider Business Mailing Address
First Line	:	PO BOX 698
Second Line	:
City	:	CUMBERLAND
State	:	MD
Zip	:	21501-0698
Country	:	US
Telephone Number	:	301-724-8727
Fax Number	:	301-724-7429

Provider Business Practice Location Address
First Line	:	900 SETON DR
Second Line	:
City	:	CUMBERLAND
State	:	MD
Zip	:	21502-1854
Country	:	US
Telephone Number	:	301-724-8727
Fax Number	:	301-724-7429

Authorized Official
Title or Position	:	M.D.
Name	:	DR. YOUNG C BAE
Credential	:	M.D.
Telephone Number	:	301-724-8727

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	08/22/2020

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