Provider Demographics
NPI:1770507733
Name:BACHTEL, JENNIFER BOZEK (PT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BOZEK
Last Name:BACHTEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:BOZEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1777 REISTERSTOWN RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1306
Mailing Address - Country:US
Mailing Address - Phone:410-415-5905
Mailing Address - Fax:410-415-5906
Practice Address - Street 1:1777 REISTERSTOWN RD
Practice Address - Street 2:SUITE 130
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-1306
Practice Address - Country:US
Practice Address - Phone:410-415-5905
Practice Address - Fax:410-415-5906
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20736174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD883LF438Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
P84013Medicare UPIN