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General NPI Number Information
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NPI Number | 1538162078
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Entity Type | Individual
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Provider Name | JOHN RICHARD BACON M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/28/2005
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Last Update Date | 05/19/2010
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Provider Practice Location Address
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Address Line | 120 SISTER PIERRE DR STE 201
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City | TOWSON
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State | MD
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Zip | 21204-7525
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Country | US
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Telephone | 410-321-0284
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Fax | 410-321-0286
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Provider Business Mailing Address
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Address Line | 120 SISTER PIERRE DR STE 201
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City | TOWSON
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State | MD
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Zip | 21204-7525
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Country | US
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Telephone | 410-321-0284
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Fax | 410-321-0286
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | D0028727
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License Number State | MD
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