Provider Demographics
NPI:1235258625
Name:BAUMSTARK, ANTHONY E (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:E
Last Name:BAUMSTARK
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 1:157 RAMPART DR
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-3370
Mailing Address - Country:US
Mailing Address - Phone:860-841-0224
Mailing Address - Fax:
Practice Address - Street 1:157 RAMPART DR
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-3370
Practice Address - Country:US
Practice Address - Phone:860-841-0224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA433702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology