MEDICARE: MR. ERIC S BAUM RN, NP-C

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	363LG0600X	Gerontology Nurse Practitioner	COA.10727-NP	OH

General Provider Information

NPI Number	:	1245465616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC S BAUM RN, NP-C

Provider Business Mailing Address
First Line	:	341 KENSINGTON RD
Second Line	:
City	:	ROCKY RIVER
State	:	OH
Zip	:	44116-1509
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4229 PEARL RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-4218
Country	:	US
Telephone Number	:	216-780-6400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2009
Last Update Date	:	02/16/2016

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