Provider Demographics
NPI:1982678710
Name:BAUER, BERTHA ANNE (MD)
Entity Type:Individual
Prefix:
First Name:BERTHA
Middle Name:ANNE
Last Name:BAUER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:227 MADISON STREET
Mailing Address - Street 2:GOUVERNEUR HEALTH
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002
Mailing Address - Country:US
Mailing Address - Phone:212-238-7000
Mailing Address - Fax:212-562-4874
Practice Address - Street 1:227 MADISON STREET
Practice Address - Street 2:GOUVERNEUR HEALTH
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002
Practice Address - Country:US
Practice Address - Phone:212-238-7000
Practice Address - Fax:212-562-4874
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2015-06-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY149334207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC11872Medicare UPIN
NY69A571Medicare PIN