Provider Demographics
NPI:1831248509
Name:DELAWARE BAY SURGICAL SERVICE, P.A.
Entity type:Organization
Organization Name:DELAWARE BAY SURGICAL SERVICE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAYER
Authorized Official - Middle Name:M
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-645-5650
Mailing Address - Street 1:33664 BAYVIEW MEDICAL DRIVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958
Mailing Address - Country:US
Mailing Address - Phone:302-644-4954
Mailing Address - Fax:302-645-5481
Practice Address - Street 1:33664 BAYVIEW MEDICAL DRIVE
Practice Address - Street 2:UNIT 2
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958
Practice Address - Country:US
Practice Address - Phone:302-644-4954
Practice Address - Fax:302-645-5481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
DELG-0000358363L00000X
DEC2-00079332086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000236002Medicaid
G00036Medicare ID - Type Unspecified