Provider Demographics
NPI:1326363292
Name:BAUER, BRUCE DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:DANIEL
Last Name:BAUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6160 KEMPSVILLE CIR STE 200A
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3945
Mailing Address - Country:US
Mailing Address - Phone:757-622-6315
Mailing Address - Fax:
Practice Address - Street 1:6160 KEMPSVILLE CIR STE 200A
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3945
Practice Address - Country:US
Practice Address - Phone:757-622-6315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101256764207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1326363292Medicaid