Active NPI
Robert A Bazewicz, MD
- Surgery Physician
- Lebanon, PA
National Provider Identifier
1801008669
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- MD04154E
- Practice address
- 229 S 4TH St
Lebanon, PA 17042 - Phone
- (717) 273-2697
- Fax
- (717) 273-0125
- NPI assigned
- May 4, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | MD04154E | PA | Primary |
Addresses
Primary practice location
229 S 4TH St
Lebanon, PA 17042
Mailing address
229 S 4TH St
Lebanon, PA 17042
Phone (717) 273-2697
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001124165001 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD04154E | PA | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178236800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1336608000000",
"number": "1801008669",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "229 S 4TH ST",
"city": "LEBANON",
"state": "PA",
"postal_code": "17042",
"telephone_number": "717-273-2697",
"fax_number": "717-273-0125"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "229 S 4TH ST",
"city": "LEBANON",
"state": "PA",
"postal_code": "17042",
"telephone_number": "717-273-2697",
"fax_number": "717-273-0125"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAZEWICZ",
"first_name": "ROBERT",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-04",
"last_updated": "2012-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "PA",
"license": "MD04154E",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001124165001",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lebanon, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.