Provider Demographics
NPI:1851356604
Name:BAUGH, WILFRETA GOURDINE (MD)
Entity Type:Individual
Prefix:DR
First Name:WILFRETA
Middle Name:GOURDINE
Last Name:BAUGH
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 1:5519 GERMANTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-2225
Mailing Address - Country:US
Mailing Address - Phone:215-438-2055
Mailing Address - Fax:215-438-1547
Practice Address - Street 1:5519 GERMANTOWN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-2225
Practice Address - Country:US
Practice Address - Phone:215-438-2055
Practice Address - Fax:215-438-1547
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024932E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB34415Medicare UPIN
PA051901Medicare ID - Type Unspecified