Provider Demographics
NPI:1891938528
Name:BAUGHMAN, AMY WISTERIA (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:WISTERIA
Last Name:BAUGHMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 BELMONT STREET
Mailing Address - Street 2:GERIATRICS & EXTENDED CARE
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301
Mailing Address - Country:US
Mailing Address - Phone:774-826-1860
Mailing Address - Fax:
Practice Address - Street 1:940 BELMONT STREET
Practice Address - Street 2:VETERANS AFFAIRS BOSTON HEALTHCARE SYSTEM
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:774-826-1860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2016-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA252442208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist