Provider Demographics
NPI:1427287663
Name:BACZEWSKI, NATASHA (DPM)
Entity type:Individual
Prefix:DR
First Name:NATASHA
Middle Name:
Last Name:BACZEWSKI
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:
Other - Last Name:LECLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:14 MANCHESTER SQ
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-8001
Mailing Address - Country:US
Mailing Address - Phone:603-431-6070
Mailing Address - Fax:603-766-0612
Practice Address - Street 1:14 MANCHESTER SQ
Practice Address - Street 2:STE 250
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-8001
Practice Address - Country:US
Practice Address - Phone:603-431-6070
Practice Address - Fax:603-766-0612
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILPR00085213E00000X
NHNH 0338213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH002760501Medicare PIN