MEDICARE: DR. ANDREW BAUMGARTNER MD

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1285263350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW BAUMGARTNER MD

Provider Business Mailing Address
First Line	:	2470 SHERIDAN DR APT 16
Second Line	:
City	:	TONAWANDA
State	:	NY
Zip	:	14150-9437
Country	:	US
Telephone Number	:	716-200-8222
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 HOPKINS RD
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14221-1729
Country	:	US
Telephone Number	:	716-688-9641
Fax Number	:

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

Provider Enumeration Date	:	04/02/2020
Last Update Date	:	04/02/2020

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