Provider Demographics
NPI:1558342899
Name:SHORE SURGICAL GROUP PA
Entity Type:Organization
Organization Name:SHORE SURGICAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:MERCER
Authorized Official - Last Name:BYSSHE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:410-822-4553
Mailing Address - Street 1:505 DUTCHMANS LN
Mailing Address - Street 2:BUILDING B
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-4302
Mailing Address - Country:US
Mailing Address - Phone:410-822-4553
Mailing Address - Fax:410-770-7611
Practice Address - Street 1:505 DUTCHMANS LN
Practice Address - Street 2:BUILDING B
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-4302
Practice Address - Country:US
Practice Address - Phone:410-822-4553
Practice Address - Fax:410-770-7611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE481OtherCAREFIRST BLUECHOICE
MDE481OtherCAREFIRST BLUECHOICE