Provider Demographics
NPI:1871032409
Name:BAY HEMATOLOGY ONCOLOGY, P.A.
Entity Type:Organization
Organization Name:BAY HEMATOLOGY ONCOLOGY, P.A.
Other - Org Name:NANCY LA BUNCE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:K
Authorized Official - Last Name:BOOZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-820-5945
Mailing Address - Street 1:2977 4H PARK RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CENTREVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21617-2232
Mailing Address - Country:US
Mailing Address - Phone:410-758-4030
Mailing Address - Fax:410-758-4733
Practice Address - Street 1:2977 4H PARK RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-2232
Practice Address - Country:US
Practice Address - Phone:410-758-4030
Practice Address - Fax:410-758-4733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC000387363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD100820000Medicaid
MD313MP150Medicare PIN