Healthcare Provider Details

I. General information

NPI: 1154598019
Provider Name (Legal Business Name): MARY HO-MONG BACH LOOD MD, PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY BACH MD, PHARMD

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 4TH PLAIN BLVD
VANCOUVER WA
98661-3713
US

IV. Provider business mailing address

1601 E 4TH PLAIN BLVD
VANCOUVER WA
98661-3713
US

V. Phone/Fax

Practice location:
  • Phone: 208-422-1145
  • Fax: 208-422-1038
Mailing address:
  • Phone: 208-422-1145
  • Fax: 208-422-1038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD60151466
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD60151466
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: