Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 72149 | MA |
NPI | 1174555155 |
---|---|
Provider Name | Laurel A Bauer |
First Address | Beverly, MA 01915 |
Second Address | Beverly, MA 01915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 27/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3063135 | (05) | MA |
E65737 | (02) |