MEDICARE: AMELIA TANNE BAUER DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS023373	PA

General Provider Information

NPI Number	:	1588227607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMELIA TANNE BAUER DO

Provider Business Mailing Address
First Line	:	10800 KNIGHTS RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-4200
Country	:	US
Telephone Number	:	215-612-5161
Fax Number	:	215-612-4069

Provider Business Practice Location Address
First Line	:	3220 TILLMAN DR STE 101
Second Line	:
City	:	BENSALEM
State	:	PA
Zip	:	19020-2028
Country	:	US
Telephone Number	:	215-639-1281
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2019
Last Update Date	:	02/26/2024

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