MEDICARE: KATHY EILEEN BAYLOR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD051777L	PA

General Provider Information

NPI Number	:	1255316030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY EILEEN BAYLOR MD

Provider Business Mailing Address
First Line	:	PO BOX 919
Second Line	:
City	:	BLOOMSBURG
State	:	PA
Zip	:	17815-0919
Country	:	US
Telephone Number	:	570-387-2144
Fax Number	:

Provider Business Practice Location Address
First Line	:	695 E 16TH ST STE B
Second Line	:
City	:	BERWICK
State	:	PA
Zip	:	18603-2320
Country	:	US
Telephone Number	:	570-759-2203
Fax Number	:	570-759-2253

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	09/24/2020

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