Healthcare Provider Details

I. General information

NPI: 1962684662
Provider Name (Legal Business Name): SONDRA LYNN BAUMCRATZ PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 WILSON AVE WASHINGTON HOSPITAL
WASHINGTON PA
15301-3336
US

IV. Provider business mailing address

PO BOX 640631 EMERGENCY MEDICINE WASHINGTON HOSPITAL
PITTSBURGH PA
15264-0631
US

V. Phone/Fax

Practice location:
  • Phone: 724-223-3342
  • Fax: 610-617-6280
Mailing address:
  • Phone: 610-668-6491
  • Fax: 610-617-6280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA002726L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: