Provider Demographics
NPI:1114035292
Name:NORTH BAY MEDICAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:NORTH BAY MEDICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOPE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIEFFENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-287-3727
Mailing Address - Street 1:322 E CECIL AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NORTH EAST
Mailing Address - State:MD
Mailing Address - Zip Code:21901-4012
Mailing Address - Country:US
Mailing Address - Phone:410-287-3727
Mailing Address - Fax:410-287-2819
Practice Address - Street 1:322 E CECIL AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:NORTH EAST
Practice Address - State:MD
Practice Address - Zip Code:21901-4012
Practice Address - Country:US
Practice Address - Phone:410-287-3727
Practice Address - Fax:410-287-2819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0023322207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG00130Medicare ID - Type Unspecified
MDMDKP83Medicare ID - Type Unspecified