=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265218440
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHADWICK BAUGH NP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2023
-----------------------------------------------------
Last Update Date | 09/05/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 274 OAKLEY AVE
-----------------------------------------------------
City | ELMONT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11003-3205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-972-8164
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 274 OAKLEY AVE
-----------------------------------------------------
City | ELMONT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11003-3205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-972-8164
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CHADWICK BAUGH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 646-972-8164
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------