Provider Demographics
NPI:1295169761
Name:RICHARD T BAUER III DPM PLLC
Entity type:Organization
Organization Name:RICHARD T BAUER III DPM PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:III
Authorized Official - Credentials:DPM
Authorized Official - Phone:518-608-4587
Mailing Address - Street 1:180 OLD LOUDON RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-3905
Mailing Address - Country:US
Mailing Address - Phone:518-608-4587
Mailing Address - Fax:518-605-4768
Practice Address - Street 1:180 OLD LOUDON RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-3905
Practice Address - Country:US
Practice Address - Phone:518-608-4587
Practice Address - Fax:518-608-4768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-02
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006435213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ100091555Medicare PIN