Provider Demographics
NPI:1952381733
Name:BAUMAN, CARLA J (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:J
Last Name:BAUMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3277 84TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3017
Mailing Address - Country:US
Mailing Address - Phone:206-275-3476
Mailing Address - Fax:
Practice Address - Street 1:626 120TH AVE NE STE B104
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3077
Practice Address - Country:US
Practice Address - Phone:425-455-3376
Practice Address - Fax:425-455-2766
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033024207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG34798Medicare UPIN
WAG217000718Medicare ID - Type UnspecifiedMEDICARE NUMBER