Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 25MA09783500 | NJ |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 25MA09783500 | NJ |
NPI | 1639464696 |
---|---|
Provider Name | Dr. Kaitlan Baston |
First Address | Camden, NJ 08103-1155 |
Second Address | Camden, NJ 08103-1438 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2011 |
Last Update Date | 14/12/2020 |