Provider Demographics
NPI:1336103894
Name:BAUM, REBECCA A (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:BAUM
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 1:2000 PERIMETER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1301 CENTRAL DR
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4159
Practice Address - Country:US
Practice Address - Phone:919-718-9512
Practice Address - Fax:919-718-9516
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350876132080P0006X
OH35-0876132080P0006X
NC2020-030142080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2153600Medicaid
OH2153600Medicaid