Provider Demographics
NPI:1447230644
Name:BAUMAN, JEANNE ANNE (MD)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:ANNE
Last Name:BAUMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:104 E 2ND ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1532
Mailing Address - Country:US
Mailing Address - Phone:814-877-5560
Mailing Address - Fax:814-877-5561
Practice Address - Street 1:104 E 2ND ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1532
Practice Address - Country:US
Practice Address - Phone:814-877-5560
Practice Address - Fax:814-877-5561
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031200E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00025609603OtherUNIVERA
OH0950163OtherOH MEDICAL ASSISTANCE
PA1536528OtherGATEWAY
WV3000453OtherW. VIRGINIA WORKERS COMP
PA0012309900008Medicaid
PA220272OtherUPMC
PA300104963OtherRR MEDICARE
PA603189OtherBLUE SHIELD
NY01613478OtherNY MEDICAL ASSISTANCE
PA88936OtherUNISON
PA603189E7CMedicare PIN
NY01613478OtherNY MEDICAL ASSISTANCE