Provider Demographics
NPI:1164498853
Name:BAUER, DOROTA E (MD)
Entity Type:Individual
Prefix:
First Name:DOROTA
Middle Name:E
Last Name:BAUER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4269 PEARL RD
Mailing Address - Street 2:STE 208
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-4234
Mailing Address - Country:US
Mailing Address - Phone:216-351-4656
Mailing Address - Fax:216-351-4454
Practice Address - Street 1:4269 PEARL RD
Practice Address - Street 2:STE 208
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-4234
Practice Address - Country:US
Practice Address - Phone:216-351-4656
Practice Address - Fax:216-351-4454
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073579B207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F73579OtherSUMMACARE APEX
OH000000510718OtherANTHEM BCBS
OH2079996Medicaid
7017156OtherAETNA
OHP00472862OtherRAILROAD CARE
OHP00472862OtherRAILROAD CARE
OH2079996Medicaid