Provider Demographics
NPI:1093710808
Name:BAER, DAVID NICHOLAS (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:NICHOLAS
Last Name:BAER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9471 MARKET ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORTH LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:44452-8702
Mailing Address - Country:US
Mailing Address - Phone:330-729-2388
Mailing Address - Fax:330-629-6468
Practice Address - Street 1:107 ROYAL BIRKDALE DR STE A
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:OH
Practice Address - Zip Code:44408
Practice Address - Country:US
Practice Address - Phone:330-482-9350
Practice Address - Fax:330-482-2336
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.002732213E00000X, 213ES0103X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0855669Medicaid
OH0530060001Medicare NSC
OH0855669Medicaid
PA039793DX2Medicare ID - Type Unspecified
OH0530060001Medicare NSC