Provider Demographics
NPI:1770050460
Name:ETHAN J. BAUGHMAN, M.D. INC., A MEDICAL CORPORATION
Entity type:Organization
Organization Name:ETHAN J. BAUGHMAN, M.D. INC., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ETHAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BAUGHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-413-9683
Mailing Address - Street 1:1560 NEWBURY RD, STE 1 #179
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:93120
Mailing Address - Country:US
Mailing Address - Phone:972-413-9683
Mailing Address - Fax:
Practice Address - Street 1:32144 AGOURA RD STE 220
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-4057
Practice Address - Country:US
Practice Address - Phone:805-409-7537
Practice Address - Fax:310-363-7610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty