Provider Demographics
NPI:1477002277
Name:MARIANNE BACHARACH, MD, PLLC
Entity Type:Organization
Organization Name:MARIANNE BACHARACH, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BACHARACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-706-8289
Mailing Address - Street 1:1905 NW 56TH TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-1409
Mailing Address - Country:US
Mailing Address - Phone:405-706-8289
Mailing Address - Fax:
Practice Address - Street 1:1905 NW 56TH TER
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-1409
Practice Address - Country:US
Practice Address - Phone:405-706-8289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21693207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty