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General NPI Number Information
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NPI Number | 1851481154
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Entity Type | Organization
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Legal Business Name | BAYSIDE INTERNAL MEDICINE PLC
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Dates
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Enumeration Date | 10/15/2006
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Last Update Date | 05/02/2013
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Provider Practice Location Address
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Address Line | 1020 INDEPENDENCE BLVD SUITE 105
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-5500
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Country | US
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Telephone | 757-318-3700
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Fax | 757-318-3701
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Provider Business Mailing Address
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Address Line | 1020 INDEPENDENCE BLVD SUITE 105
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-5500
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Country | US
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Telephone | 757-318-3700
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Fax | 757-318-3701
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MRS. STARR NICHOLS
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Credential | CPC
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Telephone | 757-363-3001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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