Healthcare Provider Details

I. General information

NPI: 1245321496
Provider Name (Legal Business Name): BAYSIDE HEMATOLOGY &ONCOLOGY P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 INDEPENDENCE BLVD SUITE 208
VIRGINIA BEACH VA
23455-5500
US

IV. Provider business mailing address

1020 INDEPENDENCE BLVD SUITE 208
VIRGINIA BEACH VA
23455-5500
US

V. Phone/Fax

Practice location:
  • Phone: 757-464-6464
  • Fax: 757-464-6424
Mailing address:
  • Phone: 757-464-6464
  • Fax: 757-464-6424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BHASKAR GADAHAD RAO
Title or Position: PRESIDENT
Credential: MD
Phone: 797-464-6464