Provider Demographics
NPI:1508874199
Name:BAUM, TIMOTHY LEWIS (CRNP)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:LEWIS
Last Name:BAUM
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E MARION ST
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-2015
Mailing Address - Country:US
Mailing Address - Phone:717-290-6900
Mailing Address - Fax:717-290-1104
Practice Address - Street 1:1861 CHARTER LN STE 118
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-5859
Practice Address - Country:US
Practice Address - Phone:717-290-6900
Practice Address - Fax:717-290-1104
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP005243H363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology