Provider Demographics
NPI:1710077482
Name:BAUMAN, PATRICIA M (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:M
Last Name:BAUMAN
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 1:750 LAS GALLINAS AVE STE 219
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3432
Mailing Address - Country:US
Mailing Address - Phone:415-472-5733
Mailing Address - Fax:415-472-5743
Practice Address - Street 1:750 LAS GALLINAS AVE
Practice Address - Street 2:SUITE #206
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3438
Practice Address - Country:US
Practice Address - Phone:415-472-5733
Practice Address - Fax:415-472-5743
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60849207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G608490Medicare ID - Type Unspecified
CAE82141Medicare UPIN