Organization
BAY STATE MEDICAL, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL R SCHAUB (CHIEF EXECUTIVE OFFICER)
(410) 859-2366
Entity
Organization
Contact information
Practice address
23475 ROCK HAVEN WAY, SUITE 120, DULLES, VA 20166-4444
(800) 643-0268
(800) 643-3577
Mailing address
7271 PARK CIRCLE DR, HANOVER, MD 21076-1325
(410) 859-2366
(410) 859-3002
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
0206009130
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0414530002
MEDICARE PTAN
VA
Enumeration date
07/15/2009
Last updated
10/17/2022
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