Provider Demographics
NPI:1386811628
Name:BAY HEMATOLOGY ONCOLOGY PA
Entity type:Organization
Organization Name:BAY HEMATOLOGY ONCOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:HALE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-820-5945
Mailing Address - Street 1:8221 TEAL DR STE 301
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-7215
Mailing Address - Country:US
Mailing Address - Phone:410-820-5945
Mailing Address - Fax:410-820-9642
Practice Address - Street 1:8221 TEAL DR STE 301
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7215
Practice Address - Country:US
Practice Address - Phone:410-820-5945
Practice Address - Fax:410-820-4059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD39887261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD091401100Medicaid
MD400462101Medicaid