MEDICARE: GEORGE FREDRICK BAHR IV

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	291611-01	NY

General Provider Information

NPI Number	:	1629900568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE FREDRICK BAHR IV

Provider Business Mailing Address
First Line	:	37 W PINE ST
Second Line	:
City	:	GLOVERSVILLE
State	:	NY
Zip	:	12078-3827
Country	:	US
Telephone Number	:	518-448-9236
Fax Number	:

Provider Business Practice Location Address
First Line	:	37 W PINE ST
Second Line	:
City	:	GLOVERSVILLE
State	:	NY
Zip	:	12078-3827
Country	:	US
Telephone Number	:	518-448-9236
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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