Provider Demographics
NPI:1740261049
Name:BAUM, CARL RAPHAEL (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:RAPHAEL
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:PO BOX 9805
Mailing Address - Street 2:300 GEORGE STREET 6TH FLOOR
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06536-0805
Mailing Address - Country:US
Mailing Address - Phone:203-785-7998
Mailing Address - Fax:
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:YALE-NEW HAVEN CHILDREN'S HOSP-EMERGENCY DEPT
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-688-7970
Practice Address - Fax:203-688-4809
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0386842080P0204X
CT036842080T0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No2080T0002XAllopathic & Osteopathic PhysiciansPediatricsMedical Toxicology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001386847Medicaid
CT001386847Medicaid
CT370001313Medicare ID - Type Unspecified