Provider Demographics
NPI:1538319041
Name:BAUMGARTNER, MERRITT LEIGH (PA-C)
Entity Type:Individual
Prefix:
First Name:MERRITT
Middle Name:LEIGH
Last Name:BAUMGARTNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1773 TYRONE ST
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2521
Mailing Address - Country:US
Mailing Address - Phone:901-827-8902
Mailing Address - Fax:
Practice Address - Street 1:1071 MD RT 3 N
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1784
Practice Address - Country:US
Practice Address - Phone:410-721-2333
Practice Address - Fax:410-721-1207
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC0005993363A00000X
VA0110003564363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant