Provider Demographics
NPI:1831135748
Name:INTERNAL MEDICINE HEALTH ASSOCIATES, PC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE HEALTH ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:G
Authorized Official - Last Name:BAUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-828-7413
Mailing Address - Street 1:2005 BAY ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-1085
Mailing Address - Country:US
Mailing Address - Phone:508-822-2266
Mailing Address - Fax:508-823-5689
Practice Address - Street 1:2005 BAY ST
Practice Address - Street 2:SUITE 206
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-1085
Practice Address - Country:US
Practice Address - Phone:508-822-2266
Practice Address - Fax:508-823-5689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM18323Medicaid
MAM21337Medicare ID - Type Unspecified