Provider Demographics
NPI:1801863774
Name:BAUMGARD, MARC (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:BAUMGARD
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 1:221 W 21ST ST
Mailing Address - Street 2:STE 1 C/O MMS
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052
Mailing Address - Country:US
Mailing Address - Phone:440-244-0010
Mailing Address - Fax:440-244-0726
Practice Address - Street 1:3700 KOLBE RD
Practice Address - Street 2:COMMUNITY HEALTH PARTNER OF OHIO CRITICAL CARE
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053
Practice Address - Country:US
Practice Address - Phone:440-960-4000
Practice Address - Fax:440-244-0726
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0263343Medicaid
OHN09276451Medicare ID - Type Unspecified
OHBA0808308Medicare ID - Type Unspecified
OH0263343Medicaid