Provider Demographics
NPI:1033289004
Name:BAUM, STEPHAN FREDRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHAN
Middle Name:FREDRICK
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:PO BOX 947
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-0947
Mailing Address - Country:US
Mailing Address - Phone:919-690-3217
Mailing Address - Fax:
Practice Address - Street 1:102 PROFESSIONAL PARK STE A
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-2554
Practice Address - Country:US
Practice Address - Phone:919-690-3217
Practice Address - Fax:919-690-3218
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97-004662084P0804X
VA01012341722084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1205NOtherBCBS OF NC
NC891205NMedicaid
NC891205NMedicaid
NCG82414Medicare UPIN