MEDICARE: BRIAN P, BACH D.P.M.

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	335E00000X	Prosthetic/Orthotic Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720266745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIAN P, BACH D.P.M.

Provider Business Mailing Address
First Line	:	9015 WOODYARD RD
Second Line	:	SUITE 211
City	:	CLINTON
State	:	MD
Zip	:	20735-4209
Country	:	US
Telephone Number	:	301-868-0087
Fax Number	:

Provider Business Practice Location Address
First Line	:	9015 WOODYARD RD
Second Line	:	SUITE 211
City	:	CLINTON
State	:	MD
Zip	:	20735-4209
Country	:	US
Telephone Number	:	301-868-0087
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	BRIAN PHILLIP BACH
Credential	:	D.P.M.
Telephone Number	:	301-868-0087

Provider Enumeration Date	:	01/31/2008
Last Update Date	:	05/01/2008

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