Provider Demographics
NPI:1104888254
Name:BAUM, RICHARD ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALAN
Last Name:BAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 CRAIN HWY
Mailing Address - Street 2:STE 410
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-6437
Mailing Address - Country:US
Mailing Address - Phone:410-766-2500
Mailing Address - Fax:410-766-2507
Practice Address - Street 1:1600 CRAIN HWY
Practice Address - Street 2:STE 410
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-6437
Practice Address - Country:US
Practice Address - Phone:410-766-2500
Practice Address - Fax:410-766-2507
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN59992207RG0100X
MDD13526207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD35442505OtherBC BS OF MD
MD371001700Medicaid
MD1470001OtherBC BS OF MD
MD35442505OtherBC BS OF MD