Provider Demographics
NPI:1083149777
Name:BAHL, NICHOLAS (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:BAHL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3122 E MERIDIAN PARK LOOP
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7255
Mailing Address - Country:US
Mailing Address - Phone:907-864-4625
Mailing Address - Fax:907-313-1540
Practice Address - Street 1:3066 E MERIDIAN PARK LOOP
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7254
Practice Address - Country:US
Practice Address - Phone:907-357-2332
Practice Address - Fax:907-357-9593
Is Sole Proprietor?:No
Enumeration Date:2017-05-01
Last Update Date:2023-11-27
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Provider Licenses
StateLicense IDTaxonomies
AK185227208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery