Provider Demographics
NPI:1598736134
Name:BARUCH, AMY ROSEANNE (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:ROSEANNE
Last Name:BARUCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 WESTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7009
Mailing Address - Country:US
Mailing Address - Phone:336-889-8446
Mailing Address - Fax:336-878-7275
Practice Address - Street 1:3333 SILAS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3013
Practice Address - Country:US
Practice Address - Phone:336-718-7041
Practice Address - Fax:336-718-9622
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200322207R00000X, 208M00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC110238916OtherRAILROAD MEDICARE
NC131GBOtherBCBS
VA1598736134Medicaid
NC200866OtherMEDCOST
NC89131G8Medicaid
NCP00479034OtherRAILROAD MEDICARE
VA1598736134Medicaid
NC200866OtherMEDCOST
NCH65073Medicare UPIN