Healthcare Provider Details

I. General information

NPI: 1124188404
Provider Name (Legal Business Name): MINA BAISCH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2006
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 A ST
PHILADELPHIA PA
19134-1043
US

IV. Provider business mailing address

3601 A ST ATTN: CREDENTIALING
PHILADELPHIA PA
19134-1043
US

V. Phone/Fax

Practice location:
  • Phone: 413-588-4838
  • Fax: 215-427-4316
Mailing address:
  • Phone: 413-588-4838
  • Fax: 215-427-4316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRN2257867
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP013211
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: