Provider Demographics
NPI:1699176875
Name:BAUER, KENDRA (PA-C)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:BAUER
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 1:6400 GOLDSBORO RD STE 400
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-5846
Mailing Address - Country:US
Mailing Address - Phone:301-263-0800
Mailing Address - Fax:301-263-0820
Practice Address - Street 1:6400 GOLDSBORO RD STE 400
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-5846
Practice Address - Country:US
Practice Address - Phone:301-263-0800
Practice Address - Fax:301-263-0820
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005501363A00000X
DC363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant