Provider Demographics
NPI:1871587568
Name:BAUMAN, JUANITA BELLE (DO)
Entity type:Individual
Prefix:DR
First Name:JUANITA
Middle Name:BELLE
Last Name:BAUMAN
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 1:317 OVERLOOK DRIVE
Mailing Address - Street 2:
Mailing Address - City:QUEENSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21658-1262
Mailing Address - Country:US
Mailing Address - Phone:410-746-8664
Mailing Address - Fax:302-934-7875
Practice Address - Street 1:317 OVERLOOK DRIVE
Practice Address - Street 2:
Practice Address - City:QUEENSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21658-1262
Practice Address - Country:US
Practice Address - Phone:410-746-8664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH36245207Q00000X
DEC2-0009822207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1348JBMedicare ID - Type Unspecified