=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134323918
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MATTHEW D. BACHARACH, MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2007
-----------------------------------------------------
Last Update Date | 01/13/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 N ARCH ST
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17603-2929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-735-7422
-----------------------------------------------------
Fax | 717-735-7424
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 330 N ARCH ST
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17603-2929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-735-7422
-----------------------------------------------------
Fax | 717-735-7424
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MATTHEW D BACHARACH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 717-735-7422
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083P0011X
-----------------------------------------------------
Taxonomy Name | Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
-----------------------------------------------------
License Number | MD037966E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | MD037966E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------