Basic Information
| Provider Information | |||||||||
| NPI: | 1538136585 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAUMGARTEL | ||||||||
| FirstName: | IRA | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 W MAIN ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SAXONBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 160562254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7243528422 | ||||||||
| FaxNumber: | 7243528426 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 W MAIN ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SAXONBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 160562254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7243528422 | ||||||||
| FaxNumber: | 7243528426 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 09/04/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD020872E | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | MA0007320670001 | 05 | PA | MEDICAID | 01073206702 | 05 | PA | MEDICAID |