Healthcare Provider Details

I. General information

NPI: 1629182340
Provider Name (Legal Business Name): MELISSA BAILEY MCCLAIN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA L BAILEY PA

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 PARK AVENUE SUITE 200
BALTIMORE MD
21201
US

IV. Provider business mailing address

1040 PARK AVENUE SUITE 200
BALTIMORE MD
21201
US

V. Phone/Fax

Practice location:
  • Phone: 443-738-0300
  • Fax: 443-738-0301
Mailing address:
  • Phone: 443-738-0300
  • Fax: 443-738-0301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC06854
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: