Provider Demographics
NPI:1245460039
Name:BAY STATE MEDICAL, INC
Entity type:Organization
Organization Name:BAY STATE MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHAUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-859-2366
Mailing Address - Street 1:7271 PARK CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-1325
Mailing Address - Country:US
Mailing Address - Phone:410-859-2366
Mailing Address - Fax:410-859-3002
Practice Address - Street 1:23475 ROCK HAVEN WAY
Practice Address - Street 2:SUITE 120
Practice Address - City:DULLES
Practice Address - State:VA
Practice Address - Zip Code:20166-4444
Practice Address - Country:US
Practice Address - Phone:800-643-0268
Practice Address - Fax:800-643-3577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0206009130332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0414530002OtherMEDICARE PTAN
VA0414530002OtherMEDICARE PTAN