Provider Demographics
NPI:1801096284
Name:BARUCH, EDWARD MITCHELL (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MITCHELL
Last Name:BARUCH
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 1:813 EAST GATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054
Mailing Address - Country:US
Mailing Address - Phone:856-273-8000
Mailing Address - Fax:856-273-6408
Practice Address - Street 1:813 EAST GATE DRIVE
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054
Practice Address - Country:US
Practice Address - Phone:856-273-8000
Practice Address - Fax:856-273-6408
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA590562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7179502Medicaid
E97245Medicare UPIN
NJ635172Medicare ID - Type Unspecified