Provider Demographics
NPI:1801162094
Name:BAUM, BERTHA (DO)
Entity type:Individual
Prefix:DR
First Name:BERTHA
Middle Name:
Last Name:BAUM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3972 194TH LN
Mailing Address - Street 2:
Mailing Address - City:GOLDEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2281
Mailing Address - Country:US
Mailing Address - Phone:786-326-9593
Mailing Address - Fax:
Practice Address - Street 1:1250 E HALLANDALE BEACH BLVD
Practice Address - Street 2:SUITE 800
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4634
Practice Address - Country:US
Practice Address - Phone:954-456-5050
Practice Address - Fax:954-456-5095
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-01
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11642207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology