| Konrad W. Bakker, M.d., P.a. | |
|
172 Thomas Johnson Dr Ste 100 Frederick MD 21702-4405 | |
| (301) 694-0900 | |
| (301) 694-0657 |
| Full Name | Konrad W. Bakker, M.d., P.a. |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 172 Thomas Johnson Dr, Frederick, Maryland |
| Authorized Official Name and Position | Willa Shriver (PRACTICE MANAGER) |
| Authorized Official Contact | 3016940900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Konrad W. Bakker, M.d., P.a. 172 Thomas Johnson Dr Ste 100 Frederick MD 21702-4405 Ph: (301) 694-0900 | Konrad W. Bakker, M.d., P.a. 172 Thomas Johnson Dr Ste 100 Frederick MD 21702-4405 Ph: (301) 694-0900 |
| NPI Number | 1972509362 |
|---|---|
| Provider Enumeration Date | 06/22/2005 |
| Last Update Date | 05/03/2012 |
| Medicare PECOS PAC ID | 0446239693 |
|---|---|
| Medicare Enrollment ID | O20060407000107 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972509362 | NPI | - | NPPES |
| 372721 | Other | VA | MAMSI/MDIPA/OC DME |
| 5113 | Other | DC | BLUE CROSS BLUE SHEILD |
| 613465 | Other | MD | MAMSI/MDIPA/OPT.CHOICE |
| KFE9CO | Other | MD | BLUE CROSS BLUE SHIELD |
| 3327089 | Other | MD | AETNA HMO |
| 3473625 | Other | VA | ATENA HMO |
| 372721 | Other | ME | MAMSI/MDIPA/OC DME |
| 4137505 | Other | MD | AETNA PPO/MC/EPO |
| 495169 | Other | MD | NCPPO |
| 526711100 | Medicaid | MD | |
| 1306711010 | Other | MD | CIGNA |
| 237074 | Other | VA | ANTHEM HEALTHKEEPERS |
| 500310 | Other | MD | UNITED HEALTHCARE |
| 237076 | Other | VA | ANTHEM BC/BS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | D0035322 (Maryland) | Primary |
| Provider Name | Konrad W Bakker |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1346246782 PECOS PAC ID: 7416936661 Enrollment ID: I20060510000162 |
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