MEDICARE: DR. MIA KATHLEEN BATES MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	208000000X	Pediatrics Physician	342563	NY

General Provider Information

NPI Number	:	1942903356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIA KATHLEEN BATES MD

Provider Business Mailing Address
First Line	:	1184 5TH AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-6503
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1184 5TH AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-6503
Country	:	US
Telephone Number	:	212-241-6937
Fax Number	:

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

Provider Enumeration Date	:	03/24/2023
Last Update Date	:	04/06/2026

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