Healthcare Provider Details

I. General information

NPI: 1760949606
Provider Name (Legal Business Name): BAYHEALTH MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WELLNESS WAY
MILFORD DE
19963-4364
US

IV. Provider business mailing address

640 S STATE ST
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 302-430-5738
  • Fax: 302-744-7181
Mailing address:
  • Phone: 302-744-7000
  • Fax: 302-744-7181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL TRETINA
Title or Position: SR. VICE PRESIDENT/ CFO
Credential:
Phone: 302-744-7162