Provider Demographics
NPI:1962653881
Name:BAYNE-POORMAN, MARIAN T (DO)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:T
Last Name:BAYNE-POORMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARIAN
Other - Middle Name:T
Other - Last Name:BAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:7645 CENTER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:NINEVEH
Mailing Address - State:IN
Mailing Address - Zip Code:46164-9642
Mailing Address - Country:US
Mailing Address - Phone:812-344-6657
Mailing Address - Fax:
Practice Address - Street 1:533 E COUNTY LINE RD STE 214
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1074
Practice Address - Country:US
Practice Address - Phone:317-215-5099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003388A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine