Provider Demographics
NPI:1922334044
Name:BAUCOM, SHARON LAVARNE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:LAVARNE
Last Name:BAUCOM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:8609 WINDSOR MILL RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-1117
Mailing Address - Country:US
Mailing Address - Phone:410-521-6901
Mailing Address - Fax:410-764-4160
Practice Address - Street 1:6776 REISTERSTOWN RD STE 315
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-2320
Practice Address - Country:US
Practice Address - Phone:410-585-3380
Practice Address - Fax:410-764-4160
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0059256207Q00000X
VA0101058726207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine