Provider Demographics
NPI:1699865626
Name:BAYVIEW PHYSICIAN SERVICES, PC
Entity type:Organization
Organization Name:BAYVIEW PHYSICIAN SERVICES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:CETRONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-686-3508
Mailing Address - Street 1:PO BOX 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-686-3508
Mailing Address - Fax:757-686-0541
Practice Address - Street 1:2000 MEADE PARKWAY
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4259
Practice Address - Country:US
Practice Address - Phone:757-934-9308
Practice Address - Fax:757-539-7582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAOH660261QR0200X, 261QR0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA50122OtherOPTIMA PROVIDER NUMBER
VA0721140OtherCIGNA PROVIDER NUMBER
VA7729551OtherAETNA PROVIDER NUMBER
VA010235499Medicaid
VAP00413966OtherRAILROAD MEDICARE
VA267286OtherANTHEM BCBS
VA7729551OtherAETNA PROVIDER NUMBER