Provider Demographics
NPI:1831194836
Name:BAUMGARTNER, TERI LYNNE (MD)
Entity type:Individual
Prefix:DR
First Name:TERI
Middle Name:LYNNE
Last Name:BAUMGARTNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BAUMGARTNER
Other - Middle Name:TERI
Other - Last Name:LYNNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:115 MEDICAL CIR STE 103
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-9004
Mailing Address - Country:US
Mailing Address - Phone:903-677-8453
Mailing Address - Fax:903-677-8454
Practice Address - Street 1:115 MEDICAL CIR STE 103
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-9004
Practice Address - Country:US
Practice Address - Phone:903-677-8453
Practice Address - Fax:903-677-8454
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6959207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178423301Medicaid
TX8S2731OtherIND. BLUE CROSS BLUE SHIE
TX216528401Medicaid
TX8S2731OtherIND. BLUE CROSS BLUE SHIE
TXG86864Medicare UPIN