Provider Demographics
NPI:1770554602
Name:BAUMAN, WAYNE E (MD)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:E
Last Name:BAUMAN
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 428668
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-8668
Mailing Address - Country:US
Mailing Address - Phone:513-984-5042
Mailing Address - Fax:513-984-8759
Practice Address - Street 1:10496 MONTGOMERY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242
Practice Address - Country:US
Practice Address - Phone:513-984-5042
Practice Address - Fax:513-984-8759
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35041847B207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0411932Medicaid
OH791071182OtherRR MEDICARE
OH0411932Medicaid
OH791071182OtherRR MEDICARE