Provider Demographics
NPI:1528245735
Name:BRIAN L. BACHELDER MD
Entity type:Organization
Organization Name:BRIAN L. BACHELDER MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BACHELDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-947-7015
Mailing Address - Street 1:642 W MARION RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338-1056
Mailing Address - Country:US
Mailing Address - Phone:419-947-7015
Mailing Address - Fax:419-947-7390
Practice Address - Street 1:642 W MARION RD
Practice Address - Street 2:
Practice Address - City:MOUNT GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338-1056
Practice Address - Country:US
Practice Address - Phone:419-947-7015
Practice Address - Fax:419-947-7390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH49315174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2246322Medicaid
OH0566070Medicaid
OH0566070Medicaid
OH2246322Medicaid
OH363840Medicare Oscar/Certification