Healthcare Provider Details

I. General information

NPI: 1023225117
Provider Name (Legal Business Name): GREGORY BAUMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 MAIN ST DEPARTMENT OF ANESTHESIOLOGY
PATERSON NJ
07503-2621
US

IV. Provider business mailing address

3998 FAIR RIDGE DR SUITE 300
FAIRFAX VA
22033-2907
US

V. Phone/Fax

Practice location:
  • Phone: 973-754-2323
  • Fax:
Mailing address:
  • Phone: 703-295-9360
  • Fax: 703-766-9725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number25MA08706900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: