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General NPI Number Information
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NPI Number | 1093354920
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Entity Type | Individual
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Provider Name | IRINA KONSTANTINOVNA BAUM NP
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Gender | Female
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Dates
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Enumeration Date | 12/23/2019
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Last Update Date | 12/23/2019
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Provider Practice Location Address
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Address Line | 3893 FORTRESS CT
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City | HAMPSTEAD
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State | MD
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Zip | 21074-1790
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Country | US
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Telephone | 240-593-2301
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Fax |
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Provider Business Mailing Address
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Address Line | 3893 FORTRESS CT
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City | HAMPSTEAD
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State | MD
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Zip | 21074-1790
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | R211137
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | R211137
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License Number State | MD
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