Provider Demographics
NPI:1053402875
Name:BAUER, STEVEN ROBERT
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ROBERT
Last Name:BAUER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12311 COPPER WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-3642
Mailing Address - Country:US
Mailing Address - Phone:704-540-1640
Mailing Address - Fax:704-540-1639
Practice Address - Street 1:12311 COPPER WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3642
Practice Address - Country:US
Practice Address - Phone:704-540-1640
Practice Address - Fax:704-540-1639
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207738207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY207738OtherNEW YORK MEDICAL LICENSE NUMBER
NY01890899Medicaid
NC2403427OtherNC CIGNA MEDICARE NUMBER
NY12V722OtherBC/BS PROVIDER #
NC2006-01723OtherNORTH CAROLINA MEDICAL LICENSE NUMBER
NC2403427OtherNC CIGNA MEDICARE NUMBER
NC2006-01723OtherNORTH CAROLINA MEDICAL LICENSE NUMBER