MEDICARE: LEONARD A BAUGHAM SR MD, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	20998	NC

General Provider Information

NPI Number	:	1184639908
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEONARD A BAUGHAM SR MD, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 1146
Second Line	:
City	:	NORTH WILKESBORO
State	:	NC
Zip	:	28659-1146
Country	:	US
Telephone Number	:	336-667-5924
Fax Number	:	336-667-4303

Provider Business Practice Location Address
First Line	:	408 8TH ST
Second Line	:
City	:	NORTH WILKESBORO
State	:	NC
Zip	:	28659-4167
Country	:	US
Telephone Number	:	336-667-5924
Fax Number	:	336-667-4303

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. ANGIE MARIE ROE
Credential	:
Telephone Number	:	336-667-5924

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	07/16/2008

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