Provider Demographics
NPI:1023164860
Name:VAN DYKE AND BACON INC.
Entity type:Organization
Organization Name:VAN DYKE AND BACON INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BACON
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:410-433-1100
Mailing Address - Street 1:5919 YORK RD
Mailing Address - Street 2:SUITEB
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-3027
Mailing Address - Country:US
Mailing Address - Phone:410-433-1100
Mailing Address - Fax:410-435-6934
Practice Address - Street 1:5919 YORK RD
Practice Address - Street 2:SUITEB
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-3027
Practice Address - Country:US
Practice Address - Phone:410-433-1100
Practice Address - Fax:410-435-6934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0305110001Medicare ID - Type UnspecifiedMEDICARE PROVIDER#