Provider Demographics
NPI:1962489534
Name:BAUMGARTEN, PAUL H (DPM)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:H
Last Name:BAUMGARTEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 SARATOGA RD, 2-1
Mailing Address - Street 2:THE FOOT DOCTOR
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-4237
Mailing Address - Country:US
Mailing Address - Phone:518-346-6000
Mailing Address - Fax:
Practice Address - Street 1:123 SARATOGA RD
Practice Address - Street 2:STE 9
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12302-4181
Practice Address - Country:US
Practice Address - Phone:518-346-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004870213E00000X
NYN 004870213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01345486Medicaid
NYDE2962Medicare PIN
NY53551AMedicare PIN