MEDICARE: BAY STATE MEDICAL, INC.

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	332BX2000X	Oxygen Equipment & Supplies (DME)	R1031	MD

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
2	Y675	OTHER	MD	CAREFIRST BCBS MD
3	F301-0001	OTHER	MD	FEDERAL BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	57766	OTHER		NORTHWOOD

General Provider Information

NPI Number	:	1881699049
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY STATE MEDICAL, INC.

Provider Business Mailing Address
First Line	:	7271 PARK CIRCLE DR
Second Line	:
City	:	HANOVER
State	:	MD
Zip	:	21076-1325
Country	:	US
Telephone Number	:	410-859-2366
Fax Number	:	410-859-3002

Provider Business Practice Location Address
First Line	:	7271 PARK CIRCLE DR
Second Line	:
City	:	HANOVER
State	:	MD
Zip	:	21076-1325
Country	:	US
Telephone Number	:	410-859-2366
Fax Number	:	410-859-3002

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DANIEL R SCHAUB
Credential	:
Telephone Number	:	410-859-2366

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	04/20/2008

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Directions to “BAY STATE MEDICAL, INC. ” Practice Location

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