Healthcare Provider Details

I. General information

NPI: 1538164918
Provider Name (Legal Business Name): BAYSIDE HEALTH ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 SAVANNAH RD
LEWES DE
19958-1611
US

IV. Provider business mailing address

1535 SAVANNAH RD
LEWES DE
19958-1611
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-4700
  • Fax: 302-645-1038
Mailing address:
  • Phone: 302-645-4700
  • Fax: 302-645-1038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number1989030027
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: DR. VINCENT B. KILLEEN
Title or Position: PRESIDENT AND CEO
Credential: MD
Phone: 302-645-4700