Provider Demographics
NPI:1306126552
Name:BAUER, RICHARD T III (DPM)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:T
Last Name:BAUER
Suffix:III
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:180 OLD LOUDON RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-3905
Mailing Address - Country:US
Mailing Address - Phone:518-608-4587
Mailing Address - Fax:518-608-4768
Practice Address - Street 1:180 OLD LOUDON RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-3905
Practice Address - Country:US
Practice Address - Phone:518-608-4587
Practice Address - Fax:518-608-4768
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006435213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3773920Medicaid
NYJ100091555Medicare PIN
NYJ400091556Medicare PIN