Healthcare Provider Details

I. General information

NPI: 1639170368
Provider Name (Legal Business Name): MONICA BAUMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 07/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ATWELL RD
COOPERSTOWN NY
13326-1301
US

IV. Provider business mailing address

PO BOX 725
COOPERSTOWN NY
13326-0725
US

V. Phone/Fax

Practice location:
  • Phone: 607-547-3153
  • Fax: 518-793-1013
Mailing address:
  • Phone: 607-547-3153
  • Fax: 607-547-6539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number38585
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number250112
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: