Healthcare Provider Details

I. General information

NPI: 1295169761
Provider Name (Legal Business Name): RICHARD T BAUER III DPM PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2013
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 OLD LOUDON RD
LATHAM NY
12110-3905
US

IV. Provider business mailing address

180 OLD LOUDON RD
LATHAM NY
12110-3905
US

V. Phone/Fax

Practice location:
  • Phone: 518-608-4587
  • Fax: 518-608-4768
Mailing address:
  • Phone: 518-608-4587
  • Fax: 518-605-4768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number006435
License Number StateNY

VIII. Authorized Official

Name: DR. RICHARD T BAUER III
Title or Position: DIRECTOR
Credential: DPM
Phone: 518-608-4587