Provider Demographics
NPI:1073517652
Name:BAYEN MEDICAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:BAYEN MEDICAL ASSOCIATES, PA
Other - Org Name:CRAMERTON CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-861-9117
Mailing Address - Street 1:1343 E GARRISON BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-5137
Mailing Address - Country:US
Mailing Address - Phone:704-861-9117
Mailing Address - Fax:704-861-0142
Practice Address - Street 1:1343 E GARRISON BLVD
Practice Address - Street 2:STE A
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-5137
Practice Address - Country:US
Practice Address - Phone:704-861-9117
Practice Address - Fax:704-861-0142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0291GOtherBLUE CROSS BLUE SHIELD
NC0291GOtherBLUE CROSS BLUE SHIELD