Individual provider · NPI-1

Dr. Benjamin Jared Bauer, M.D.

Family Medicine · Pawtucket, RI

NPI number1629399951
StatusActive
Last updated in NPPESJun 22, 2010

Details

NPI
1629399951
Entity type
Individual (NPI-1)
Name
Dr. Benjamin Jared Bauer
Credential
M.D.
Sex
Male
Sole proprietor
Yes
Enumeration date
Jun 22, 2010
Last updated
Jun 22, 2010

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family MedicineLP01903RIYes

Practice location

111 Brewster St
Fcc A
Pawtucket, RI 02860-4474

Phone 401-729-3469 · Fax 401-729-2541

Mailing address

111 Brewster St
Fcc A
Pawtucket, RI 02860-4474

Phone 401-729-3469 · Fax 401-729-2541

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