Provider Demographics
NPI:1558373316
Name:BAUMAN, LYLE W (MD)
Entity Type:Individual
Prefix:DR
First Name:LYLE
Middle Name:W
Last Name:BAUMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LYLE
Other - Middle Name:W
Other - Last Name:BAUMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1203 SNIDER ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4221
Mailing Address - Country:US
Mailing Address - Phone:276-782-9113
Mailing Address - Fax:276-782-9833
Practice Address - Street 1:1203 SNIDER ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-4221
Practice Address - Country:US
Practice Address - Phone:276-782-9113
Practice Address - Fax:276-782-9833
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049504208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA282451OtherANTHEM
VA7367899Medicaid
VA7367899Medicaid
VA020019591Medicare PIN
VAF34292Medicare UPIN