Provider Demographics
NPI:1245202043
Name:BAUER, BRENDAN W (MD)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:W
Last Name:BAUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5319 HOAG DR STE 210
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44035-1495
Mailing Address - Country:US
Mailing Address - Phone:440-925-5378
Mailing Address - Fax:440-925-5379
Practice Address - Street 1:5319 HOAG DR STE 210
Practice Address - Street 2:
Practice Address - City:SHEFFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44035-1495
Practice Address - Country:US
Practice Address - Phone:419-483-2403
Practice Address - Fax:419-483-8418
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350811792084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH249289OtherANTHEM INS
OHP00059998OtherRAILROAD MEDICARE
OH11211352OtherCAQH
OH2330356Medicaid
OH7926405OtherAETNA INS
OH04236OtherPARAMOUNT
OH11211352OtherCAQH
OH4091621Medicare PIN