Provider Demographics
NPI:1366420473
Name:BAUER, MYRIAM FARKOUH (MD)
Entity type:Individual
Prefix:DR
First Name:MYRIAM
Middle Name:FARKOUH
Last Name:BAUER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MYRIAM
Other - Middle Name:
Other - Last Name:FARKOUH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:919 WESTFALL RD.
Mailing Address - Street 2:BUILDING A, SUITE 105
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:14618
Mailing Address - Country:US
Mailing Address - Phone:585-244-9720
Mailing Address - Fax:585-244-9995
Practice Address - Street 1:919 WESTFALL RD.
Practice Address - Street 2:BUILDING A, SUITE 105
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618
Practice Address - Country:US
Practice Address - Phone:585-244-9720
Practice Address - Fax:585-244-9995
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD427342208000000X
NY249619208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
I4666Medicare UPIN
PAI14666Medicare UPIN