Healthcare Provider Details

I. General information

NPI: 1205860970
Provider Name (Legal Business Name): TED ALBERT BAUMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 FAIRVIEW ST
CLINTON NC
28328-2399
US

IV. Provider business mailing address

403 FAIRVIEW ST
CLINTON NC
28328-2399
US

V. Phone/Fax

Practice location:
  • Phone: 910-592-6011
  • Fax: 910-592-0819
Mailing address:
  • Phone: 910-592-6011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2001-00305
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: