Provider Demographics
NPI:1386616290
Name:BAUER, JASON
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:BAUER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 PARK SQUARE LN
Mailing Address - Street 2:SUITE 200, CWING
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-3158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 PARK SQUARE LN
Practice Address - Street 2:SUITE 200, CWING
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-3158
Practice Address - Country:US
Practice Address - Phone:412-772-1371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN525318L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA050514OtherMEDICARE GROUP #
PA1007307260035OtherMEDICAID GROUP #
PA101222211Medicaid
PARN525318LOtherLICENSE
PA050514OtherMEDICARE GROUP #
PARN525318LOtherLICENSE
PAQ33383Medicare UPIN