Provider Demographics
NPI:1891958526
Name:BAUGH, MIRANDA B (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MIRANDA
Middle Name:B
Last Name:BAUGH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 N PARHAM RD STE 315
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4434
Mailing Address - Country:US
Mailing Address - Phone:804-288-8327
Mailing Address - Fax:
Practice Address - Street 1:2810 N PARHAM RD STE 315
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4424
Practice Address - Country:US
Practice Address - Phone:804-288-8327
Practice Address - Fax:804-282-3744
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2023-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002791363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAMC11074Medicare PIN
VAVAA113403Medicare PIN
VAMC11072Medicare PIN
VAMC11071Medicare PIN
VAMC11073Medicare PIN