Healthcare Provider Details

I. General information

NPI: 1255619854
Provider Name (Legal Business Name): TAMARA MARIE BAUM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMARA MARIE JETTE M.D.

II. Dates (important events)

Enumeration Date: 07/30/2011
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WOODS RD
VALHALLA NY
10595-1530
US

IV. Provider business mailing address

110 LAMB TAVERN LN
GLENMOORE PA
19343-1818
US

V. Phone/Fax

Practice location:
  • Phone: 914-231-8373
  • Fax:
Mailing address:
  • Phone: 617-763-6896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD453089
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMT200298
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number34200101
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD453089
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number34200101
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD453089
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: