Basic Information
| Provider Information | |||||||||
| NPI: | 1366409682 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAILEY | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9782 HWY 903 | ||||||||
| Address2: | |||||||||
| City: | BRACEY | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4346366903 | ||||||||
| FaxNumber: | 4346363826 | ||||||||
| Practice Location | |||||||||
| Address1: | 9782 HWY 903 | ||||||||
| Address2: | |||||||||
| City: | BRACEY | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23919 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4346366903 | ||||||||
| FaxNumber: | 4346363826 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2006 | ||||||||
| LastUpdateDate: | 02/25/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0101041235 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 005641659 | 05 | VA | MEDICAID | 080042374 | 01 | VA | MEDICARE RAILROAD | OTHER | 092375 | 01 | VA | ANTHEM BCBS VA | OTHER |