Provider Demographics
NPI:1376771329
Name:BAUMRIND, BENJAMIN ROSEN (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ROSEN
Last Name:BAUMRIND
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 1:1425 ELLSWORTH INDUSTRIAL BLVD NW STE 36
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-4154
Mailing Address - Country:US
Mailing Address - Phone:404-512-1590
Mailing Address - Fax:
Practice Address - Street 1:1425 ELLSWORTH INDUSTRIAL BLVD NW STE 36
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-4154
Practice Address - Country:US
Practice Address - Phone:404-512-1590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA069539207W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003134697GMedicaid