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General NPI Number Information
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NPI Number | 1245460039
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Entity Type | Organization
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Legal Business Name | BAY STATE MEDICAL, INC
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Dates
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Enumeration Date | 07/15/2009
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 23475 ROCK HAVEN WAY SUITE 120
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City | DULLES
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State | VA
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Zip | 20166-4444
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Country | US
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Telephone | 800-643-0268
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Fax | 800-643-3577
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Provider Business Mailing Address
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Address Line | 7271 PARK CIRCLE DR
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City | HANOVER
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State | MD
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Zip | 21076-1325
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Country | US
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Telephone | 410-859-2366
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Fax | 410-859-3002
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DANIEL R SCHAUB
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Credential |
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Telephone | 410-859-2366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 0206009130
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License Number State | VA
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