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General NPI Number Information
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NPI Number | 1861564965
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Entity Type | Individual
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Provider Name | SHAD M BAAB M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 09/12/2011
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Provider Practice Location Address
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Address Line | 1200 N ELM ST
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City | GREENSBORO
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State | NC
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Zip | 27401-1004
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Country | US
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Telephone | 336-716-2255
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Fax | 336-716-5438
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Provider Business Mailing Address
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Address Line | PO BOX 602598 WAKE FOREST UNIVERSITY HEALTH SCIENCES
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City | CHARLOTTE
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State | NC
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Zip | 28260-2598
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Country | US
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Telephone | 336-716-2255
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Fax | 336-716-5438
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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 | 207PP0204X
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Taxonomy Name | Pediatric Emergency Medicine (Emergency Medicine) Physician
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License Number | 2010-01562
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License Number State | NC
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