Healthcare Provider Details

I. General information

NPI: 1861564965
Provider Name (Legal Business Name): SHAD M BAAB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 09/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N ELM ST
GREENSBORO NC
27401-1004
US

IV. Provider business mailing address

PO BOX 602598 WAKE FOREST UNIVERSITY HEALTH SCIENCES
CHARLOTTE NC
28260-2598
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-2255
  • Fax: 336-716-5438
Mailing address:
  • Phone: 336-716-2255
  • Fax: 336-716-5438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number2010-01562
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: