Provider Demographics
NPI:1487742425
Name:BAILEY, SUSAN A, (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:A,
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1580 VALENCIA ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-4420
Mailing Address - Country:US
Mailing Address - Phone:415-550-4711
Mailing Address - Fax:415-282-6703
Practice Address - Street 1:1580 VALENCIA ST STE 201
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4420
Practice Address - Country:US
Practice Address - Phone:415-550-4711
Practice Address - Fax:415-282-6703
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG296122086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G296120Medicaid
CAA44087Medicare UPIN
CA00G296120Medicaid