MEDICARE: MARIA BAENS 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	207R00000X	Internal Medicine Physician	15077	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447256672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA BAENS M.D.

Provider Business Mailing Address
First Line	:	1818 HENDERSON ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2619
Country	:	US
Telephone Number	:	803-758-2602
Fax Number	:	803-253-8896

Provider Business Practice Location Address
First Line	:	200 MIDDLEBURG DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-3408
Country	:	US
Telephone Number	:	843-903-6650
Fax Number	:	843-903-0758

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	10/20/2015

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