Healthcare Provider Details

I. General information

NPI: 1164585675
Provider Name (Legal Business Name): WAYNE E. BAUMAN, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 04/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10496 MONTGOMERY RD SUITE 201
CINCINNATI OH
45242
US

IV. Provider business mailing address

PO BOX 428668
CINCINNATI OH
45242-8668
US

V. Phone/Fax

Practice location:
  • Phone: 513-984-5042
  • Fax: 513-984-8759
Mailing address:
  • Phone: 513-984-5042
  • Fax: 513-984-8759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35041847B
License Number StateOH

VIII. Authorized Official

Name: WAYNE E. BAUMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 513-984-5042