Provider Demographics
NPI:1457430811
Name:BHAUMIK, JUTHIKA (MD,MPH)
Entity Type:Individual
Prefix:DR
First Name:JUTHIKA
Middle Name:
Last Name:BHAUMIK
Suffix:
Gender:F
Credentials:MD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 N EUTAW ST
Mailing Address - Street 2:210
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-4648
Mailing Address - Country:US
Mailing Address - Phone:410-383-2250
Mailing Address - Fax:410-383-8378
Practice Address - Street 1:821 N EUTAW ST
Practice Address - Street 2:210
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4648
Practice Address - Country:US
Practice Address - Phone:410-383-2250
Practice Address - Fax:410-383-8378
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0018274208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1200233Medicaid
MD82621OtherM.D.I.P.A
MDEO66 0001OtherB.C/B.S-FEDERAL
MD139771100Medicaid
MD1585OtherBLUE CROSS/BLUE SHIELD
MD4124464OtherAETNA