Provider Demographics
NPI:1366409682
Name:BAILEY, PAUL A SR (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:BAILEY
Suffix:SR
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 1:9782 HWY 903
Mailing Address - Street 2:
Mailing Address - City:BRACEY
Mailing Address - State:VA
Mailing Address - Zip Code:23919
Mailing Address - Country:US
Mailing Address - Phone:434-636-6903
Mailing Address - Fax:434-636-3826
Practice Address - Street 1:9782 HWY 903
Practice Address - Street 2:
Practice Address - City:BRACEY
Practice Address - State:VA
Practice Address - Zip Code:23919
Practice Address - Country:US
Practice Address - Phone:434-636-6903
Practice Address - Fax:434-636-3826
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041235207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005641659Medicaid
VA080042374OtherMEDICARE RAILROAD
VA092375OtherANTHEM BCBS VA
D98439Medicare UPIN
VA005641659Medicaid