Provider Demographics
NPI:1316195639
Name:BACH, THOMAS R (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:R
Last Name:BACH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29897 PEIRCE WAY
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-4915
Mailing Address - Country:US
Mailing Address - Phone:410-822-8609
Mailing Address - Fax:410-822-8646
Practice Address - Street 1:29897 PEIRCE WAY
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-4915
Practice Address - Country:US
Practice Address - Phone:410-822-8609
Practice Address - Fax:410-822-8646
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD626103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical