Provider Demographics
NPI:1265439772
Name:BAUM, ALICIA (MD)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:
Last Name:BAUM
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 1:8700 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:15642-2762
Mailing Address - Country:US
Mailing Address - Phone:724-863-7530
Mailing Address - Fax:724-863-8213
Practice Address - Street 1:8700 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:NORTH HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:15642-2762
Practice Address - Country:US
Practice Address - Phone:724-863-7530
Practice Address - Fax:724-863-8213
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019988E207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000048869OtherHIGHMARK BLUE SHIELD
PA1010403OtherGATEWAY HEALTH PLAN
PA45688OtherHEALTH AMERICA/ASSURANCE
PA534192OtherAETNA
PA204024OtherUPMC HEALTH PLANS
PA0007298300001Medicaid
PA66358OtherMEDPLUS
PA048869Medicare ID - Type Unspecified
PA204024OtherUPMC HEALTH PLANS