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Organization
BAYSIDE INTERNAL MEDICINE LLC
Active
Organization
BAYSIDE INTERNAL MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PRASHANT REHIT SHUKLA MD (OWNER)
(410) 297-9500
Entity
Organization
Contact information
Practice address
998 HOSPITALITY WAY, SUITE 102, BAYSIDE INTERNAL MEDICINE, LLC, ABERDEEN, MD 21001-1757
(410) 297-9500
(410) 297-9016
Mailing address
998 HOSPITALITY WAY, SUITE 102, BAYSIDE INTERNAL MEDICINE, LLC, ABERDEEN, MD 21001-1757
(410) 297-9500
(410) 297-9016
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
489M
MEDICARE
MD
01
—
DG3049
RAILROAD MEDICARE
GA
01
—
G738
CAREFIRST
DC
01
—
KEB4BA
CAREFIRST
MD
01
—
NO GROUP #
MEDICAL ASSISTANCE OF MD
MD
Enumeration date
10/29/2007
Last updated
06/29/2012
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