Provider Demographics
NPI:1407812068
Name:BAHNER, RICHARD SCOTT (MD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:SCOTT
Last Name:BAHNER
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 1:2716 ASHTON DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2489
Mailing Address - Country:US
Mailing Address - Phone:910-332-3800
Mailing Address - Fax:910-763-8804
Practice Address - Street 1:3787 SHIPYARD BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-6148
Practice Address - Country:US
Practice Address - Phone:910-332-3800
Practice Address - Fax:910-763-8804
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701690207X00000X
NC9710690207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891220MMedicaid
P01048082OtherRR MEDICARE PTAN
P01048082OtherRR MEDICARE PTAN
NC5227AMedicare PIN