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NPI Code Detail

MEDICARE: MR. BRANDON MATTHEW BACH

MEDICARE: MR. BRANDON MATTHEW BACH
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
1106S00000XBehavior TechnicianBACB1543870VA

General Provider Information

NPI Number : 1639033574
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRANDON MATTHEW BACH
Provider Business Mailing Address
First Line : 313 ELDEN STREET
Second Line : SUITE 302
City : HERNDON
State : VA
Zip : 20170
Country : US
Telephone Number : 540-562-9997
Fax Number :
Provider Business Practice Location Address
First Line : 3433 BRAMBLETON AVE STE 201A
Second Line :
City : ROANOKE
State : VA
Zip : 24018-6527
Country : US
Telephone Number : 540-562-9997
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2025
Last Update Date : 06/01/2026

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