Provider Demographics
NPI:1659006450
Name:BAUMAN, KENTSTON (PA-C)
Entity Type:Individual
Prefix:
First Name:KENTSTON
Middle Name:
Last Name:BAUMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 WOODBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-1128
Mailing Address - Country:US
Mailing Address - Phone:734-883-3203
Mailing Address - Fax:
Practice Address - Street 1:103 WOODBRIDGE ST
Practice Address - Street 2:
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-1128
Practice Address - Country:US
Practice Address - Phone:734-883-3203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program