Provider Demographics
NPI:1679594022
Name:BAIRD, TERRY M (MD)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:M
Last Name:BAIRD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30313 PROVINCETOWN LN
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-1741
Mailing Address - Country:US
Mailing Address - Phone:440-250-0572
Mailing Address - Fax:
Practice Address - Street 1:30313 PROVINCETOWN LN
Practice Address - Street 2:
Practice Address - City:BAY VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44140-1741
Practice Address - Country:US
Practice Address - Phone:440-250-0572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0552922080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000183454OtherANTHEM
OH0760761Medicaid
OH000000183454OtherANTHEM
OHF13559Medicare UPIN