1881699049 NPI number — BAY STATE MEDICAL, INC.

Table of content: (NPI 1881699049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881699049 NPI number — BAY STATE MEDICAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAY STATE MEDICAL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881699049
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7271 PARK CIRCLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HANOVER
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21076-1325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-859-2366
Provider Business Mailing Address Fax Number:
410-859-3002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7271 PARK CIRCLE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HANOVER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21076-1325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-859-2366
Provider Business Practice Location Address Fax Number:
410-859-3002
Provider Enumeration Date:
06/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SCHAUB
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-859-2366

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  R1031 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 025302100 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: Y675 . This is a "CAREFIRST BCBS MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: F301-0001 . This is a "FEDERAL BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 089118500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 57766 . This is a "NORTHWOOD" identifier . This identifiers is of the category "OTHER".




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