Basic Information
| Provider Information | |||||||||
| NPI: | 1881840551 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | STEPHANIE BAIRD | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 222 SAINT JOHN ST STE 226 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041023058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078715060 | ||||||||
| FaxNumber: | 2078392197 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 SAINT JOHN ST STE 226 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041023058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078715060 | ||||||||
| FaxNumber: | 2078392197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2008 | ||||||||
| LastUpdateDate: | 08/14/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BAIRD | ||||||||
| AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 2078715060 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | ACUPUNCTURIST | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | AC159 | ME | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Acupuncturist |
ID Information
| ID | Type | State | Issuer | Description | 031098 | 01 | ME | ANTHEM | OTHER |