Healthcare Provider Details

I. General information

NPI: 1083726723
Provider Name (Legal Business Name): BRIAN PHILLIP BACH DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9015 WOODYARD #211
CLINTON MD
20735
US

IV. Provider business mailing address

9015 WOODYARD #211
CLINTON MD
20735
US

V. Phone/Fax

Practice location:
  • Phone: 301-868-0087
  • Fax:
Mailing address:
  • Phone: 301-868-0087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number908
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: