Provider Demographics
NPI:1851131155
Name:MADAMA-BAUMGAERTEL, NICHOLAS (PA)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:MADAMA-BAUMGAERTEL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:NICHOLAS
Other - Middle Name:
Other - Last Name:BAUMGAERTEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:107 RACQUET CLUB RD # 107
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-3135
Mailing Address - Country:US
Mailing Address - Phone:740-590-8530
Mailing Address - Fax:
Practice Address - Street 1:107 RACQUET CLUB RD # 107
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-3135
Practice Address - Country:US
Practice Address - Phone:740-590-8530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program