Healthcare Provider Details

I. General information

NPI: 1962941575
Provider Name (Legal Business Name): BAY HEMATOLOGY ONCOLOGY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2977 4H PARK RD SUITE 102
CENTREVILLE MD
21617-2232
US

IV. Provider business mailing address

2977 4H PARK RD SUITE 102
CENTREVILLE MD
21617-2232
US

V. Phone/Fax

Practice location:
  • Phone: 410-758-4030
  • Fax: 410-758-4733
Mailing address:
  • Phone: 410-758-4030
  • Fax: 410-758-4733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR216298
License Number StateMD

VIII. Authorized Official

Name: SHARON K BOOZE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 410-820-5945