Provider Demographics
NPI:1972602985
Name:BAILEY, DAVID G (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 S PROSPECT ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-6283
Mailing Address - Country:US
Mailing Address - Phone:740-383-5252
Mailing Address - Fax:740-383-6653
Practice Address - Street 1:990 S PROSPECT ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6283
Practice Address - Country:US
Practice Address - Phone:740-383-5252
Practice Address - Fax:740-383-6653
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350-48955207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0514634Medicaid
OH411013043OtherMEDICARE RAILROAD
OH000000119229OtherANTHEM
OHA15364Medicare UPIN
OH0514634Medicaid
OH0529562Medicare ID - Type Unspecified