Provider Demographics
NPI:1609812353
Name:BAUER, VALERIE PAPACONSTANTINOU (MD)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:PAPACONSTANTINOU
Last Name:BAUER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:
Other - Last Name:PAPACONSTANTINOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 824967
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-4967
Mailing Address - Country:US
Mailing Address - Phone:800-941-8933
Mailing Address - Fax:732-918-8940
Practice Address - Street 1:2211 CHAPEL AVE W STE 301
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-2062
Practice Address - Country:US
Practice Address - Phone:856-665-2017
Practice Address - Fax:856-488-6769
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11338500208C00000X
TXM1500208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R518Medicare PIN
TX8G6730Medicare PIN
TXP00393666Medicare PIN
TXCI5830Medicare PIN