Provider Demographics
NPI:1306887245
Name:BACH, TAMI (MD)
Entity type:Individual
Prefix:
First Name:TAMI
Middle Name:
Last Name:BACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 DEMOCRAT RD
Mailing Address - Street 2:
Mailing Address - City:MICKLETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08056-1236
Mailing Address - Country:US
Mailing Address - Phone:856-423-0754
Mailing Address - Fax:
Practice Address - Street 1:174 DEMOCRAT RD
Practice Address - Street 2:
Practice Address - City:MICKLETON
Practice Address - State:NJ
Practice Address - Zip Code:08056-1236
Practice Address - Country:US
Practice Address - Phone:856-423-0754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08174400207RH0003X
PAMD071653L207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010207620001Medicaid
PA082287Medicare PIN
PA1010207620001Medicaid