Provider Demographics
NPI:1578024105
Name:BAUGHMAN, VANCE P
Entity Type:Individual
Prefix:
First Name:VANCE
Middle Name:P
Last Name:BAUGHMAN
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 1:325 LAFAYETTE ST UNIT 1003
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-5472
Mailing Address - Country:US
Mailing Address - Phone:443-814-3731
Mailing Address - Fax:
Practice Address - Street 1:325 LAFAYETTE ST UNIT 1003
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-5472
Practice Address - Country:US
Practice Address - Phone:443-814-3731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical