Provider Demographics
NPI:1114008059
Name:BAUMAN, PHILLIP A (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:A
Last Name:BAUMAN
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 1:343 W 58TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1108
Mailing Address - Country:US
Mailing Address - Phone:212-765-2260
Mailing Address - Fax:212-977-3732
Practice Address - Street 1:343 W 58TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1108
Practice Address - Country:US
Practice Address - Phone:212-765-2260
Practice Address - Fax:212-977-3732
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151377207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02E321Medicare PIN
NYA96926Medicare UPIN