Individual
DR. MARVIN BAULA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4464 S DIXIE HWY, MIDDLETOWN, OH 45005-5464
(513) 649-8008
Mailing address
1101 SUMMIT RD, CINCINNATI, OH 45237-2621
(513) 948-3721
(513) 948-8631
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
35.099925
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0074861
MEDICAID-ODADAS
OH
01
—
0074946
MEDICAID-ODMH
OH
01
—
01-0693
CARF CERTIFICATION
OH
01
—
H130910
MEDICARE GROUP PTAN
OH
Enumeration date
12/30/2009
Last updated
10/15/2019
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