MEDICARE: BETHANY PRIMARY CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	C1-0009184	DE
2	363L00000X	Nurse Practitioner	LG-0000463	DE
3	363L00000X	Nurse Practitioner	LG-0000712	DE
4	207R00000X	Internal Medicine Physician	C1-0008098	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508872052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHANY PRIMARY CARE

Provider Business Mailing Address
First Line	:	33188 COASTAL HWY
Second Line	:	SUITE 4
City	:	BETHANY BEACH
State	:	DE
Zip	:	19930-3779
Country	:	US
Telephone Number	:	302-537-1100
Fax Number	:	302-537-0921

Provider Business Practice Location Address
First Line	:	33188 COASTAL HWY
Second Line	:	SUITE 4
City	:	BETHANY BEACH
State	:	DE
Zip	:	19930-3779
Country	:	US
Telephone Number	:	302-537-1100
Fax Number	:	302-537-0921

Authorized Official
Title or Position	:	OWNER
Name	:	RAJSHEKAR NARASIMAIAH
Credential	:	M.D.
Telephone Number	:	302-537-1100

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/09/2014

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Directions to “BETHANY PRIMARY CARE ” Practice Location

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