Provider Demographics
NPI:1629033105
Name:BAUGHMAN, OTIS L III (MD)
Entity type:Individual
Prefix:DR
First Name:OTIS
Middle Name:L
Last Name:BAUGHMAN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E WOOD ST
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-3040
Mailing Address - Country:US
Mailing Address - Phone:864-560-6644
Mailing Address - Fax:864-560-6063
Practice Address - Street 1:101 E WOOD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-560-6644
Practice Address - Fax:864-560-6063
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCB 8802207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1351Medicaid
SCD908053365Medicare PIN
SC5084Medicare UPIN
SCD90805Medicare ID - Type Unspecified
SCGP1351Medicaid