Provider Demographics
NPI:1679551717
Name:BAUER, THOMAS L (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:BAUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4701 OGLETOWN STANTON RD
Mailing Address - Street 2:HELEN F. GRAHAM CANCER CENTER, SUITE 2100
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2055
Mailing Address - Country:US
Mailing Address - Phone:302-623-4530
Mailing Address - Fax:302-623-4578
Practice Address - Street 1:4701 OGLETOWN STANTON RD
Practice Address - Street 2:HELEN F. GRAHAM CANCER CENTER, SUITE 2100
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2055
Practice Address - Country:US
Practice Address - Phone:302-623-4530
Practice Address - Fax:302-623-4578
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10004454208G00000X
DEC1-0004454208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEH55613Medicare UPIN
DE00B034C98Medicare PIN