Provider Demographics
NPI:1508872052
Name:BETHANY PRIMARY CARE
Entity Type:Organization
Organization Name:BETHANY PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAJSHEKAR
Authorized Official - Middle Name:
Authorized Official - Last Name:NARASIMAIAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-537-1100
Mailing Address - Street 1:33188 COASTAL HWY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BETHANY BEACH
Mailing Address - State:DE
Mailing Address - Zip Code:19930-3779
Mailing Address - Country:US
Mailing Address - Phone:302-537-1100
Mailing Address - Fax:302-537-0921
Practice Address - Street 1:33188 COASTAL HWY
Practice Address - Street 2:SUITE 4
Practice Address - City:BETHANY BEACH
Practice Address - State:DE
Practice Address - Zip Code:19930-3779
Practice Address - Country:US
Practice Address - Phone:302-537-1100
Practice Address - Fax:302-537-0921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2014-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0008098207R00000X
DEC1-00091842084P0800X
DELG-0000463363L00000X
DELG-0000712363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000014404Medicaid
G00906Medicare ID - Type Unspecified