Provider Demographics
NPI:1821269754
Name:BAUMGART, EGBERT D (MD)
Entity Type:Individual
Prefix:
First Name:EGBERT
Middle Name:D
Last Name:BAUMGART
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 1:17 OLD ROLLINSFORD ROAD, SUITE 3
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2892
Mailing Address - Country:US
Mailing Address - Phone:608-742-5011
Mailing Address - Fax:603-742-3530
Practice Address - Street 1:17 OLD ROLLINSFORD ROAD, SUITE 3
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2892
Practice Address - Country:US
Practice Address - Phone:608-742-5011
Practice Address - Fax:603-742-3530
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14244208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30209901Medicaid
NH001336302Medicare PIN