Healthcare Provider Details

I. General information

NPI: 1356470710
Provider Name (Legal Business Name): GERALD PATRICK BAILEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2007
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GREENWICH PL
SHELTON CT
06484-4618
US

IV. Provider business mailing address

29 PUNKUP RD
OXFORD CT
06478-1725
US

V. Phone/Fax

Practice location:
  • Phone: 866-393-7434
  • Fax:
Mailing address:
  • Phone: 203-751-9744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License Number223472
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number223472
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: