Provider Demographics
NPI:1174742043
Name:BAILEY, MARY CAROL LEBLANC (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:CAROL LEBLANC
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:400 GRESHAM DRIVE
Mailing Address - Street 2:402 MEDICAL TOWER
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507
Mailing Address - Country:US
Mailing Address - Phone:757-627-7446
Mailing Address - Fax:757-624-1121
Practice Address - Street 1:400 GRESHAM DRIVE
Practice Address - Street 2:402 MEDICAL TOWER
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507
Practice Address - Country:US
Practice Address - Phone:757-627-7446
Practice Address - Fax:757-624-1121
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053031207ZP0101X, 207ZP0102X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1174742043Medicaid
VA1174742043Medicaid