Provider Demographics
NPI:1134699606
Name:STEPHANIE
Entity type:Organization
Organization Name:STEPHANIE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:BAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:OTR,LAC,MAC
Authorized Official - Phone:207-871-5060
Mailing Address - Street 1:28 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2238
Mailing Address - Country:US
Mailing Address - Phone:207-871-5060
Mailing Address - Fax:
Practice Address - Street 1:222 SAINT JOHN ST STE 226
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3058
Practice Address - Country:US
Practice Address - Phone:207-871-5060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHANIE A BAIRD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service