Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | R211137 | MD |
N | 207QG0300X | Family Doctor - Geriatric Medicine | R211137 | MD |
NPI | 1093354920 |
---|---|
Provider Name | Irina Konstantinovna Baum |
First Address | Hampstead, MD 21074-1790 |
Second Address | Hampstead, MD 21074-1790 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2019 |
Last Update Date | 23/12/2019 |