Provider Demographics
NPI:1609816214
Name:BAISDEN, JOSEPH M (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:BAISDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:210 NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2136
Practice Address - Country:US
Practice Address - Phone:304-425-1960
Practice Address - Fax:304-425-9988
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012372522085R0001X
WV246882085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP01001412OtherRAILROAD MEDICARE
VAPAROtherUNITED HEALTH CARE/MAMSI
VA1609816214Medicaid
VAPAROtherTRICARE/CHAMPUS
VAPAROtherVA HEALTH NETWORK
VA10058965OtherOPTIMA HEALTH PLAN
VAPAROtherUSA MANAGED CARE (EVMS HEALTH SERVICES)
VAPAROtherCIGNA
VAPAROtherCORVEL/CORCARE (EVMS HEALTH SERVICES)
WVWV24688OtherTHE HEALTH PLAN OF THE UPPER OHIO VALLEY
NC5914565Medicaid
WVP01060034OtherRAILROAD MEDICARE - WVRTSI
WV3810022555Medicaid
VA403902OtherANTHEM BC/BS EVMS HEALTH SERVICES
VAPAROtherMULTIPLAN (EVMS HEALTH SERVICES)
VAPAROtherFIRST HEALTH COMMERCIAL/COVENTRY HEALTH/SOUTHERN HEALTH
VA403901OtherANTHEM BC/BS EVMS HEALTH SERVICES
WV9303191OtherAETNA
VAPAROtherVA PREMIER HEALTH (EVMS HEALTH SERVICES)
VAPAROtherAETNA
VA1609816214Medicaid
VAPAROtherUSA MANAGED CARE (EVMS HEALTH SERVICES)
VAPAROtherFIRST HEALTH COMMERCIAL/COVENTRY HEALTH/SOUTHERN HEALTH
VAPAROtherVA PREMIER HEALTH (EVMS HEALTH SERVICES)
WVWV1001AMedicare PIN