Provider Demographics
NPI:1134323918
Name:MATTHEW D. BACHARACH, MD
Entity Type:Organization
Organization Name:MATTHEW D. BACHARACH, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:D
Authorized Official - Last Name:BACHARACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-735-7422
Mailing Address - Street 1:330 N ARCH ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-2929
Mailing Address - Country:US
Mailing Address - Phone:717-735-7422
Mailing Address - Fax:717-735-7424
Practice Address - Street 1:330 N ARCH ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2929
Practice Address - Country:US
Practice Address - Phone:717-735-7422
Practice Address - Fax:717-735-7424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037966E2083P0011X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty