Provider Demographics
NPI:1356439228
Name:BACHELDER, BRIAN L (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:L
Last Name:BACHELDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5710
Mailing Address - Country:US
Mailing Address - Phone:614-702-7655
Mailing Address - Fax:614-706-1770
Practice Address - Street 1:5156 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2424
Practice Address - Country:US
Practice Address - Phone:614-702-7655
Practice Address - Fax:614-706-1770
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35--049315207V00000X
OH35-049315207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0290886OtherAGMC- CFM MEDICAID GROUP #
OH0558476OtherPPG INDIVIDUAL MEDICARE #
OH1821035940OtherAGMC - CFM TYPE 2 NPI #
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI #
OH3600271OtherAGMC - CFM MEDICARE GROUP #
OH0566070Medicaid
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
A15892Medicare UPIN