Provider Demographics
NPI:1962495838
Name:BAYHEALTH MEDICAL CENTER / KENT GENERAL HOSPITAL
Entity Type:Organization
Organization Name:BAYHEALTH MEDICAL CENTER / KENT GENERAL HOSPITAL
Other - Org Name:BAYHEALTH MEDICAL CENTER / MILFORD MEMORIAL HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT MEDICAL AFFAIRS
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:F
Authorized Official - Last Name:OLIVA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:302-744-7039
Mailing Address - Street 1:15 GOLDENROD LN
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:DE
Mailing Address - Zip Code:19962-9365
Mailing Address - Country:US
Mailing Address - Phone:302-335-1380
Mailing Address - Fax:
Practice Address - Street 1:640 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-3530
Practice Address - Country:US
Practice Address - Phone:302-744-7039
Practice Address - Fax:302-735-3848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC20006782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E21283Medicare UPIN
DE011262M20Medicare ID - Type UnspecifiedWALK-IN MEDICAL CARE