Healthcare Provider Details

I. General information

NPI: 1508872052
Provider Name (Legal Business Name): BETHANY PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33188 COASTAL HWY SUITE 4
BETHANY BEACH DE
19930-3779
US

IV. Provider business mailing address

33188 COASTAL HWY SUITE 4
BETHANY BEACH DE
19930-3779
US

V. Phone/Fax

Practice location:
  • Phone: 302-537-1100
  • Fax: 302-537-0921
Mailing address:
  • Phone: 302-537-1100
  • Fax: 302-537-0921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC1-0008098
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC1-0009184
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0000463
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0000712
License Number StateDE

VIII. Authorized Official

Name: RAJSHEKAR NARASIMAIAH
Title or Position: OWNER
Credential: M.D.
Phone: 302-537-1100