Healthcare Provider Details

I. General information

NPI: 1477761252
Provider Name (Legal Business Name): MICHAEL R BAUM PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6438 TAULER CT
COLUMBIA MD
21045-4530
US

IV. Provider business mailing address

6438 TAULER CT
COLUMBIA MD
21045-4530
US

V. Phone/Fax

Practice location:
  • Phone: 410-381-7832
  • Fax:
Mailing address:
  • Phone: 410-381-7832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number1781
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: