Provider Demographics
NPI:1790769792
Name:RENOM DE LA BAUME, HENRI (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRI
Middle Name:
Last Name:RENOM DE LA BAUME
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 DEWITT LOOP
Mailing Address - Street 2:
Mailing Address - City:FORT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060-5285
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9501 FARRELL ROAD
Practice Address - Street 2:DEWITT ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060
Practice Address - Country:US
Practice Address - Phone:703-805-0071
Practice Address - Fax:703-805-0189
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD34498171000000X
IN01068264A207RG0100X, 282N00000X
MDMD34498207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No171000000XOther Service ProvidersMilitary Health Care Provider
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00892039OtherRAILROAD MEDICARE
INP00892039OtherRAILROAD MEDICARE