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General NPI Number Information
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NPI Number | 1538319041
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Entity Type | Individual
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Provider Name | MERRITT LEIGH BAUMGARTNER PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/22/2008
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Last Update Date | 04/18/2017
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Provider Practice Location Address
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Address Line | 1071 MD RT 3 N
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City | GAMBRILLS
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State | MD
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Zip | 21054-1784
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Country | US
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Telephone | 410-721-2333
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Fax | 410-721-1207
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Provider Business Mailing Address
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Address Line | 1773 TYRONE ST
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City | CROFTON
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State | MD
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Zip | 21114-2521
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Country | US
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Telephone | 901-827-8902
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C0005993
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110003564
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License Number State | VA
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