Provider Demographics
NPI:1760478812
Name:BAUGHMAN, CHAD D (PA-C)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:D
Last Name:BAUGHMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 N UNIVERSITY BLVD
Practice Address - Street 2:STE 3100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5149
Practice Address - Country:US
Practice Address - Phone:317-963-7285
Practice Address - Fax:317-963-7313
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103885363AM0700X
IN100000724A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000940829OtherANTHEM PTAN
IN10000724AOtherLICENSE
IN000000939875OtherANTHEM PTAN
IN000001176213OtherANTHEM PTAN
FLPA9103885OtherLICENSE
IN300014028Medicaid