Provider Demographics
NPI:1023016060
Name:BAUM, PHILLIP ADAM (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:ADAM
Last Name:BAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N MAPLEMERE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3178
Mailing Address - Country:US
Mailing Address - Phone:716-836-4646
Mailing Address - Fax:716-836-4696
Practice Address - Street 1:111 N MAPLEMERE RD STE 120
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-3178
Practice Address - Country:US
Practice Address - Phone:716-836-4646
Practice Address - Fax:716-836-4696
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2387322085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
205805FFOtherPREFERRED CARE
000529146001OtherBLUE SHIELD WNY
160447OtherGHI
1614085OtherINDEPENDENT HEALTH
NY02863569Medicaid
00028079102OtherUNIVERA
160448OtherGHI
P010238732OtherBLUE CHOICE
71105000049OtherFIDELIS
P020238732OtherBLUE SHIELD ROCHESTER
RB6767Medicare PIN
P020238732OtherBLUE SHIELD ROCHESTER
1614085OtherINDEPENDENT HEALTH
NY02863569Medicaid