Provider Demographics
NPI:1972098754
Name:BACH, EDWARD M (DO)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:M
Last Name:BACH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:750 E ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 NOYES ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-3854
Practice Address - Country:US
Practice Address - Phone:315-738-4440
Practice Address - Fax:315-738-4460
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY3137782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry