Provider Demographics
NPI:1497712764
Name:BAUMGARTNER, MD PC, THOMAS A
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:BAUMGARTNER, MD PC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2825 FORT MISSOULA RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7420
Mailing Address - Country:US
Mailing Address - Phone:406-542-2116
Mailing Address - Fax:406-542-1425
Practice Address - Street 1:2825 FORT MISSOULA RD
Practice Address - Street 2:SUITE 304
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7420
Practice Address - Country:US
Practice Address - Phone:406-542-2116
Practice Address - Fax:406-542-1425
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4051207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0056784Medicaid
MT0056784Medicaid
AB7599270OtherDEA
C64114Medicare UPIN