Basic Information
| Provider Information | |||||||||
| NPI: | 1083849392 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAUER | ||||||||
| FirstName: | AMANDA | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 E JEFFERSON ST | ||||||||
| Address2: | KAISER PERMANENTE MEDICARE ENROLLMENT | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208524908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018162424 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7141 SECURITY BLVD | ||||||||
| Address2: | KAISER PERMANENTE WOODLAWN MEDICAL CENTER | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212441811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4436636000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2009 | ||||||||
| LastUpdateDate: | 06/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 20A 10715 | CA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 253789 | NY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | H75050 | MD | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 03135568 | 05 | NY | MEDICAID |