Provider Demographics
NPI:1033561733
Name:BAUM, JUSTIN THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:THOMAS
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 1:701 OSTRUM ST STE 602
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1184
Mailing Address - Country:US
Mailing Address - Phone:484-526-6000
Mailing Address - Fax:833-814-7406
Practice Address - Street 1:701 OSTRUM ST STE 602
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1184
Practice Address - Country:US
Practice Address - Phone:484-526-6000
Practice Address - Fax:833-814-7406
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.028290390200000X
PAMD480055207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program