Healthcare Provider Details

I. General information

NPI: 1699865626
Provider Name (Legal Business Name): BAYVIEW PHYSICIAN SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MEADE PARKWAY
SUFFOLK VA
23434-4259
US

IV. Provider business mailing address

PO BOX 7068
PORTSMOUTH VA
23707-0068
US

V. Phone/Fax

Practice location:
  • Phone: 757-934-9308
  • Fax: 757-539-7582
Mailing address:
  • Phone: 757-686-3508
  • Fax: 757-686-0541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License NumberOH660
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberOH660
License Number StateVA

VIII. Authorized Official

Name: JEFFREY DAVID FORMAN
Title or Position: DIRECTOR
Credential:
Phone: 757-923-9604