Healthcare Provider Details

I. General information

NPI: 1093790164
Provider Name (Legal Business Name): MARC D BAER DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 E HAVERFORD RD FL 3
BRYN MAWR PA
19010-3838
US

IV. Provider business mailing address

931 E HAVERFORD RD FL 3
BRYN MAWR PA
19010-3838
US

V. Phone/Fax

Practice location:
  • Phone: 610-642-5040
  • Fax: 610-642-5042
Mailing address:
  • Phone: 610-642-5040
  • Fax: 610-642-5042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00273700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC004682L
License Number StatePA

VIII. Authorized Official

Name: DR. MARC D BAER
Title or Position: PRESIDENT
Credential: DPM
Phone: 610-642-5040