Provider Demographics
NPI:1275566184
Name:BAETZ-GREENWALT, BARBARA A (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:BAETZ-GREENWALT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5910 LANDERBROOK DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-6508
Mailing Address - Country:US
Mailing Address - Phone:440-684-5829
Mailing Address - Fax:440-449-1555
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-7700
Practice Address - Fax:440-449-1555
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0457922080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0656535Medicaid
OH5429031OtherAETNA
OH80063OtherQUALCHOICE
OH1201917OtherUHC
OH000000026882OtherANTHEM
OHA82646Medicare UPIN
OHBA0843137Medicare ID - Type Unspecified