Provider Demographics
NPI:1124088745
Name:BAILEY, MARY CHRISTINE (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CHRISTINE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 WOODCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02461
Mailing Address - Country:US
Mailing Address - Phone:617-965-7618
Mailing Address - Fax:
Practice Address - Street 1:2014 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462
Practice Address - Country:US
Practice Address - Phone:617-243-6040
Practice Address - Fax:617-243-6924
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73199207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
436574OtherHP
731682OtherTUFTS
J11338OtherBLUE SHIELD
MA3078647Medicaid
J11338OtherBLUE SHIELD
731682OtherTUFTS