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General NPI Number Information
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NPI Number | 1528245735
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Entity Type | Organization
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Legal Business Name | BRIAN L. BACHELDER MD
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Dates
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Enumeration Date | 01/30/2008
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Last Update Date | 10/03/2008
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Provider Practice Location Address
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Address Line | 642 W MARION RD
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City | MOUNT GILEAD
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State | OH
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Zip | 43338-1056
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Country | US
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Telephone | 419-947-7015
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Fax | 419-947-7390
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Provider Business Mailing Address
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Address Line | 642 W MARION RD
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City | MOUNT GILEAD
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State | OH
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Zip | 43338-1056
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Country | US
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Telephone | 419-947-7015
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Fax | 419-947-7390
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRIAN L BACHELDER
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Credential | M.D.
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Telephone | 419-947-7015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 49315
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License Number State | OH
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