Provider Demographics
NPI:1306810767
Name:BAYLIS, LINELL (MD)
Entity type:Individual
Prefix:
First Name:LINELL
Middle Name:
Last Name:BAYLIS
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 1:6100 W JEFFERSON ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-3901
Mailing Address - Country:US
Mailing Address - Phone:215-877-0100
Mailing Address - Fax:215-877-7014
Practice Address - Street 1:6100 W JEFFERSON ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-3901
Practice Address - Country:US
Practice Address - Phone:215-877-0100
Practice Address - Fax:215-877-7014
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037736L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA006036780004Medicaid
BA36947Medicare UPIN
PA006036780004Medicaid