Provider Demographics
NPI:1851416408
Name:BAUGHAM, ILA EVANS (MD)
Entity Type:Individual
Prefix:
First Name:ILA
Middle Name:EVANS
Last Name:BAUGHAM
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 1:2359 HIGHWAY 105
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607
Mailing Address - Country:US
Mailing Address - Phone:828-265-5391
Mailing Address - Fax:828-265-5394
Practice Address - Street 1:2359 HIGHWAY 105
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-7814
Practice Address - Country:US
Practice Address - Phone:828-265-5391
Practice Address - Fax:828-265-5394
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25771208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13903OtherBLUE CROSS BLUE SHIELD
NC13903OtherBLUE CROSS BLUE SHIELD