Provider Demographics
NPI:1902882129
Name:BAUSCH, ANDREW N (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:N
Last Name:BAUSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 W ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-2012
Mailing Address - Country:US
Mailing Address - Phone:610-432-0201
Mailing Address - Fax:610-434-1210
Practice Address - Street 1:1616 W ALLEN ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-2012
Practice Address - Country:US
Practice Address - Phone:610-432-0201
Practice Address - Fax:610-434-1210
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031392E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB37846Medicare UPIN
PA028612Medicare ID - Type Unspecified