Healthcare Provider Details

I. General information

NPI: 1922094325
Provider Name (Legal Business Name): MICHAEL RAYMOND BAUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL DR STE 103
BARNESVILLE OH
43713-1098
US

IV. Provider business mailing address

100 HOSPITAL DR STE 103
BARNESVILLE OH
43713-1098
US

V. Phone/Fax

Practice location:
  • Phone: 740-425-5190
  • Fax: 740-425-5197
Mailing address:
  • Phone: 740-425-5190
  • Fax: 740-425-5197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOH35043893B
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number19816
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number35-04-3893B
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35043893
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: