Provider Demographics
NPI:1720266745
Name:BRIAN P, BACH D.P.M.
Entity type:Organization
Organization Name:BRIAN P, BACH D.P.M.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:BACH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-868-0087
Mailing Address - Street 1:9015 WOODYARD RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-4209
Mailing Address - Country:US
Mailing Address - Phone:301-868-0087
Mailing Address - Fax:
Practice Address - Street 1:9015 WOODYARD RD
Practice Address - Street 2:SUITE 211
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4209
Practice Address - Country:US
Practice Address - Phone:301-868-0087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD380598100Medicaid
MD380598100Medicaid
MD0958720001Medicare NSC
MDT30930Medicare UPIN