Provider Demographics
NPI:1699772772
Name:BAILYN, RONALD E (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:E
Last Name:BAILYN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ADELBERT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-6512
Mailing Address - Country:US
Mailing Address - Phone:207-772-8634
Mailing Address - Fax:207-772-1629
Practice Address - Street 1:121 MIDDLE ST
Practice Address - Street 2:SUITE 404
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4156
Practice Address - Country:US
Practice Address - Phone:207-772-8634
Practice Address - Fax:207-772-1629
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0118742084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B86321Medicare UPIN
MEMM038001Medicare PIN