Provider Demographics
NPI:1245583467
Name:BAHR, CECELIA L (PA-C)
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:L
Last Name:BAHR
Suffix:
Gender:F
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 1:416 DURANT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-0090
Mailing Address - Country:US
Mailing Address - Phone:434-774-2581
Mailing Address - Fax:434-447-4704
Practice Address - Street 1:416 DURANT ST
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970
Practice Address - Country:US
Practice Address - Phone:434-774-2581
Practice Address - Fax:434-447-4704
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004027363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical