Individual
MARY THERESA BAUER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
6701 ROCKSIDE RD, #260, INDEPENDENCE, OH 44131-2358
(216) 369-2525
(216) 369-2531
Mailing address
6701 ROCKSIDE RD, #260, INDEPENDENCE, OH 44131-2358
(216) 369-2525
(216) 369-2531
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1498
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000493627
ANTHEM
OH
Enumeration date
10/12/2005
Last updated
05/14/2009
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