1134323918 NPI number — MATTHEW D. BACHARACH, MD

Table of content: (NPI 1134323918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134323918 NPI number — MATTHEW D. BACHARACH, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MATTHEW D. BACHARACH, MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134323918
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 N ARCH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17603-2929
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-735-7422
Provider Business Mailing Address Fax Number:
717-735-7424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 N ARCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17603-2929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-735-7422
Provider Business Practice Location Address Fax Number:
717-735-7424
Provider Enumeration Date:
06/13/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BACHARACH
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
717-735-7422

Provider Taxonomy Codes

  • Taxonomy code: 2083P0011X , with the licence number:  MD037966E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: MD037966E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)