Provider Demographics
NPI:1609027408
Name:BAUMGARTNER, CLARICE MS (MD)
Entity Type:Individual
Prefix:
First Name:CLARICE
Middle Name:MS
Last Name:BAUMGARTNER
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 1:2245 BLAKE ST APT B
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-2053
Mailing Address - Country:US
Mailing Address - Phone:303-895-5455
Mailing Address - Fax:
Practice Address - Street 1:2245 BLAKE ST APT B
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-2053
Practice Address - Country:US
Practice Address - Phone:720-802-0924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL2552390200000X
CO48382207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO41258266Medicaid
CO41258266Medicaid
CO41258266Medicaid