1225371107 NPI number — TAD BAUM, M.D., P.C.

Table of content: (NPI 1225371107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225371107 NPI number — TAD BAUM, M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAD BAUM, M.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225371107
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 MEMORIAL DR
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
LEOMINSTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01453-2238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-534-2426
Provider Business Mailing Address Fax Number:
978-534-4711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 MEMORIAL DR
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
LEOMINSTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01453-2238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-534-2426
Provider Business Practice Location Address Fax Number:
978-534-4711
Provider Enumeration Date:
03/29/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BAUM
Authorized Official First Name:
TAD
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
978-534-2426

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  150333 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 151588 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2135111 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0800773 . This is a "UNITEED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 40918 . This is a "DAVIS VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 150333 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3150356 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: J16528 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 977333 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: B20757203 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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