1164498853 NPI number — DOROTA E BAUER MD

Table of content: DOROTA E BAUER MD (NPI 1164498853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164498853 NPI number — DOROTA E BAUER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAUER
Provider First Name:
DOROTA
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164498853
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4269 PEARL RD
Provider Second Line Business Mailing Address:
STE 208
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44109-4234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-351-4656
Provider Business Mailing Address Fax Number:
216-351-4454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4269 PEARL RD
Provider Second Line Business Practice Location Address:
STE 208
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44109-4234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-351-4656
Provider Business Practice Location Address Fax Number:
216-351-4454
Provider Enumeration Date:
02/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  35073579B , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: F73579 . This is a "SUMMACARE APEX" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000510718 . This is a "ANTHEM BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2079996 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7017156 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00472862 . This is a "RAILROAD CARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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