Healthcare Provider Details

I. General information

NPI: 1073671129
Provider Name (Legal Business Name): JAMES R BAUGH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 HAMAKER CT SUITE 200
FAIRFAX VA
22031-2238
US

IV. Provider business mailing address

4115 ORCHARD DR
FAIRFAX VA
22032-1022
US

V. Phone/Fax

Practice location:
  • Phone: 703-573-2432
  • Fax: 703-280-9350
Mailing address:
  • Phone: 703-273-6714
  • Fax: 703-280-9350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101043664
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: