Provider Demographics
NPI:1538265434
Name:BAUMGARDNER, GAVIN PAUL (DO)
Entity type:Individual
Prefix:DR
First Name:GAVIN
Middle Name:PAUL
Last Name:BAUMGARDNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 920
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-6920
Mailing Address - Country:US
Mailing Address - Phone:614-595-1055
Mailing Address - Fax:614-923-7813
Practice Address - Street 1:55 HOSPITAL DR
Practice Address - Street 2:SUITE 1545
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2302
Practice Address - Country:US
Practice Address - Phone:740-593-5551
Practice Address - Fax:614-923-7813
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.007628208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2347320Medicaid
OH2347320Medicaid
H67801Medicare UPIN
OH2347320Medicaid