Healthcare Provider Details

I. General information

NPI: 1881613792
Provider Name (Legal Business Name): RICHARD D BAUGHMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 OLD ETNA RD DH - DERMATOLOGY
LEBANON NH
03766
US

IV. Provider business mailing address

1 MEDICAL CENTER DR DHMC DERMATOLOGY
LEBANON NH
03756-1000
US

V. Phone/Fax

Practice location:
  • Phone: 603-650-3100
  • Fax: 603-650-3174
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number3488
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number042-0006880
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number3488
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number042-0006880
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: