Organization
JOHN R BACON, MD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN RICHARD BACON MD (ALLERGIST)
(410) 321-0284
Entity
Organization
Contact information
Practice address
120 SISTER PIERRE DR STE 201, TOWSON, MD 21204-7525
(410) 321-0284
Mailing address
120 SISTER PIERRE DR STE 201, TOWSON, MD 21204-7525
(410) 321-0284
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
D0028727
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
26692-1800
—
MD
01
—
B66916
MEDICARE
MD
Enumeration date
09/08/2010
Last updated
09/08/2010
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