Provider Demographics
NPI:1962619023
Name:BAULE, RAYMOND MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:MICHAEL
Last Name:BAULE
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:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-0112
Mailing Address - Country:US
Mailing Address - Phone:252-903-8657
Mailing Address - Fax:
Practice Address - Street 1:500 MONTAUK HWY STE K
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4419
Practice Address - Country:US
Practice Address - Phone:252-903-8657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400101207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89136TJMedicaid
NCG62857Medicare UPIN
NC2029867AMedicare ID - Type Unspecified