Provider Demographics
NPI:1801862453
Name:BAUMGART, JUDY R (MD)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:R
Last Name:BAUMGART
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 1:1622 KENILWORTH ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-3525
Mailing Address - Country:US
Mailing Address - Phone:843-422-6800
Mailing Address - Fax:
Practice Address - Street 1:1622 KENILWORTH ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-3525
Practice Address - Country:US
Practice Address - Phone:843-422-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032640E207L00000X
SC23517207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAA01188Medicare UPIN
PA449705Medicare ID - Type Unspecified