Basic Information
| Provider Information | |||||||||
| NPI: | 1033393871 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAKSH | ||||||||
| FirstName: | WAHEED | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 TAVERN RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MARTINSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 254012864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042636165 | ||||||||
| FaxNumber: | 3042636536 | ||||||||
| Practice Location | |||||||||
| Address1: | 1839 WEST PLAZA DRIVE | ||||||||
| Address2: | |||||||||
| City: | WINCHESTER | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5407732689 | ||||||||
| FaxNumber: | 5404684166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2007 | ||||||||
| LastUpdateDate: | 11/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 60267385 | NY | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 068103 | GA | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208100000X | 0101254060 | VA | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 2081P2900X | 0101254060 | VA | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | 2081P2900X | D0087846 | MD | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | 208VP0000X | 25285 | WV | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 225100000X | 029209 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2081P2900X | 25285 | WV | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0101254060 | 01 | VA | MEDICAL LICENSE | OTHER | 25285 | 01 | WV | WEST VIRGINIA BOARD OF MEDICINE | OTHER | D0087846 | 01 | MD | MARYLAND BOARD OF PHYSICIANS | OTHER |