Provider Demographics
NPI:1386601656
Name:BAYLOR, ETHEL R (DPM)
Entity type:Individual
Prefix:DR
First Name:ETHEL
Middle Name:R
Last Name:BAYLOR
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 519
Mailing Address - Street 2:
Mailing Address - City:WOODS HOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02543
Mailing Address - Country:US
Mailing Address - Phone:508-457-1019
Mailing Address - Fax:
Practice Address - Street 1:342A GIFFORD ST
Practice Address - Street 2:FALMOUTH PODIATRY
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540
Practice Address - Country:US
Practice Address - Phone:508-540-5164
Practice Address - Fax:508-540-5175
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1850213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T56494Medicare UPIN
Y70863Medicare ID - Type Unspecified