Healthcare Provider Details

I. General information

NPI: 1750942900
Provider Name (Legal Business Name): DEREK J BAUGHMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 ROOSEVELT AVE STE 204
YORK PA
17404-2244
US

IV. Provider business mailing address

243 CURTISS RD STE 100
BARKSDALE AFB LA
71110-2425
US

V. Phone/Fax

Practice location:
  • Phone: 717-356-6250
  • Fax:
Mailing address:
  • Phone: 318-456-6555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD477601
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: