Provider Demographics
NPI:1073502910
Name:BAISCH, TIM J (MD)
Entity Type:Individual
Prefix:
First Name:TIM
Middle Name:J
Last Name:BAISCH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:77 HOSPITAL AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NORTH ADAMS
Mailing Address - State:MA
Mailing Address - Zip Code:01247-2550
Mailing Address - Country:US
Mailing Address - Phone:413-664-5999
Mailing Address - Fax:413-663-7257
Practice Address - Street 1:77 HOSPITAL AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:NORTH ADAMS
Practice Address - State:MA
Practice Address - Zip Code:01247-2550
Practice Address - Country:US
Practice Address - Phone:413-664-5999
Practice Address - Fax:413-663-7257
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2010-01-11
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Provider Licenses
StateLicense IDTaxonomies
MA75783208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1004139Medicaid
MA3095797Medicaid
VT1004139Medicaid
MAJ12870Medicare PIN