Provider Demographics
NPI:1023638442
Name:BAVARIA, MICHAELA (DO)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:BAVARIA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 WOODGLEN RD
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-1324
Mailing Address - Country:US
Mailing Address - Phone:272-639-5755
Mailing Address - Fax:
Practice Address - Street 1:2650 WOODGLEN RD
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-1324
Practice Address - Country:US
Practice Address - Phone:272-639-5755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-27
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS022975207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine