Provider Demographics
NPI:1619926748
Name:BAUDEAN, MARIE LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:LOUISE
Last Name:BAUDEAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISE
Other - Middle Name:
Other - Last Name:BAUDEAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:980 HIGHWAY 29 S
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045
Mailing Address - Country:US
Mailing Address - Phone:770-962-8025
Mailing Address - Fax:770-822-1573
Practice Address - Street 1:980 HIGHWAY 29 S
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045
Practice Address - Country:US
Practice Address - Phone:770-962-8025
Practice Address - Fax:770-822-1573
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023898208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
D28882Medicare UPIN