Healthcare Provider Details

I. General information

NPI: 1629965678
Provider Name (Legal Business Name): MR. CHRISTOPHER EDWARD BAUR II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/23/2025
Certification Date: 06/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W LANCASTER AVE
PAOLI PA
19301-1763
US

IV. Provider business mailing address

507 ALEXANDER AVE
DREXEL HILL PA
19026-5203
US

V. Phone/Fax

Practice location:
  • Phone: 484-565-1000
  • Fax:
Mailing address:
  • Phone: 856-381-7381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP032827
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: