Healthcare Provider Details

I. General information

NPI: 1184068330
Provider Name (Legal Business Name): MR. THOMAS GERARD BAILOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 04/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 BAYWINDS COURT
DAGSBORO DE
19939
US

IV. Provider business mailing address

316 BAYWINDS COURT
DAGSBORO DE
19939
US

V. Phone/Fax

Practice location:
  • Phone: 302-245-9986
  • Fax: 302-537-4141
Mailing address:
  • Phone: 302-245-9986
  • Fax: 302-537-4141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number13-93071-54
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: