Provider Demographics
NPI:1487953618
Name:STREET, ESTHER JOAN (MD)
Entity type:Individual
Prefix:DR
First Name:ESTHER
Middle Name:JOAN
Last Name:STREET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ESTHER
Other - Middle Name:JOAN
Other - Last Name:BAUSCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:401 TECHNOLOGY LN STE 200
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-5040
Mailing Address - Country:US
Mailing Address - Phone:336-789-2922
Mailing Address - Fax:336-789-0856
Practice Address - Street 1:401 TECHNOLOGY LN STE 200
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030-5040
Practice Address - Country:US
Practice Address - Phone:336-789-2922
Practice Address - Fax:336-789-0856
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLO207R00000X
NC2019-01951207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine