Provider Demographics
NPI:1275614240
Name:BADER, DEREN ELAINE (CPM, DRPH)
Entity Type:Individual
Prefix:DR
First Name:DEREN
Middle Name:ELAINE
Last Name:BADER
Suffix:
Gender:F
Credentials:CPM, DRPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 GILDERSLEEVE WOOD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-3207
Mailing Address - Country:US
Mailing Address - Phone:434-975-2697
Mailing Address - Fax:434-295-8326
Practice Address - Street 1:1208 BLAND CIR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-4115
Practice Address - Country:US
Practice Address - Phone:434-989-5021
Practice Address - Fax:434-295-8326
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife