Healthcare Provider Details

I. General information

NPI: 1184043176
Provider Name (Legal Business Name): ANDREA BAUCHAT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 PRATT ST # 8047
DURHAM NC
27705-3976
US

IV. Provider business mailing address

136 WINDRUSH LN
DURHAM NC
27703-9449
US

V. Phone/Fax

Practice location:
  • Phone: 404-606-2023
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number305400
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number2021-02710
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: