Provider Demographics
NPI:1043321532
Name:BAY HEMATOLOGY ONCOLOGY PA
Entity Type:Organization
Organization Name:BAY HEMATOLOGY ONCOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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
Mailing Address - Street 2:SUITE 301
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-7227
Mailing Address - Country:US
Mailing Address - Phone:410-820-5945
Mailing Address - Fax:410-820-9642
Practice Address - Street 1:8221 TEAL DR
Practice Address - Street 2:SUITE 301
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7227
Practice Address - Country:US
Practice Address - Phone:410-820-5945
Practice Address - Fax:410-820-9642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD39887174400000X
MD2132443332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD400462100Medicaid
MD5079060001Medicare NSC
MD313MDMedicare PIN