Provider Demographics
NPI:1932212420
Name:BAYSIDE NEUROLOGY
Entity type:Organization
Organization Name:BAYSIDE NEUROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:508-984-0050
Mailing Address - Street 1:1071 KEMPTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-1529
Mailing Address - Country:US
Mailing Address - Phone:508-984-0050
Mailing Address - Fax:508-984-0049
Practice Address - Street 1:1071 KEMPTON ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-1529
Practice Address - Country:US
Practice Address - Phone:508-984-0050
Practice Address - Fax:508-984-0049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9785167Medicaid
MAM20654Medicare ID - Type Unspecified