Provider Demographics
NPI:1174504260
Name:BYSSHE, STANLEY MARCER JR (MD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:MARCER
Last Name:BYSSHE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:505 DUTCHMANS LN
Mailing Address - Street 2:BUILDING B
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-4302
Mailing Address - Country:US
Mailing Address - Phone:410-822-4553
Mailing Address - Fax:410-770-9611
Practice Address - Street 1:505 DUTCHMANS LN
Practice Address - Street 2:BUILDING B
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-4302
Practice Address - Country:US
Practice Address - Phone:410-822-4553
Practice Address - Fax:410-770-9611
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD230662086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE4810001OtherCAREFIRST BLUECHOICE
MD22322OtherMAMSI
MDV248Medicare ID - Type Unspecified
MD22322OtherMAMSI
MDS000Medicare ID - Type Unspecified