Provider Demographics
NPI:1164412375
Name:BAUM, RONALD MARC (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:MARC
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 1:22343 DELIA CT
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-5889
Mailing Address - Country:US
Mailing Address - Phone:818-888-4577
Mailing Address - Fax:818-888-4579
Practice Address - Street 1:22343 DELIA CT
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-5889
Practice Address - Country:US
Practice Address - Phone:818-888-4577
Practice Address - Fax:818-888-4579
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93128174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG52046BMedicare ID - Type Unspecified
CAA93128Medicare UPIN