Healthcare Provider Details

I. General information

NPI: 1184600876
Provider Name (Legal Business Name): DEBRA LYNNE BAVARI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1434 PORTER ST BARQUIST ARMY HEALTH CLINIC
FREDERICK MD
21702-9210
US

IV. Provider business mailing address

1434 PORTER ST BARQUIST ARMY HEALTH CLINIC
FREDERICK MD
21702-9210
US

V. Phone/Fax

Practice location:
  • Phone: 301-619-7175
  • Fax: 301-619-7676
Mailing address:
  • Phone: 301-619-7175
  • Fax: 301-619-7676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD065028-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: