Basic Information
| Provider Information | |||||||||
| NPI: | 1659728699 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAUMANN | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HELMER | ||||||||
| OtherFirstName: | RACHEL | ||||||||
| OtherMiddleName: | D | ||||||||
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| OtherCredential: | PA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 110 KINGSLEY LN STE 305 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235054617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578895422 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 110 KINGSLEY LN STE 305 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235054617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578895422 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2016 | ||||||||
| LastUpdateDate: | 06/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0110005384 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 10170220P | 01 | VA | OPTIMA HEALTH | OTHER | 1659728699 | 01 | VA | HUMANA | OTHER | 599608 | 01 | VA | BLUE CROSS BLUE SHIELD MEDICARE SUPPLEMENT | OTHER | 1659728699 | 05 | VA | MEDICAID |