Healthcare Provider Details

I. General information

NPI: 1548239791
Provider Name (Legal Business Name): RICHARD A BAILEY JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 STRUTHERS LIBERTY RD
CAMPBELL OH
44405-1949
US

IV. Provider business mailing address

315 STRUTHERS LIBERTY RD
CAMPBELL OH
44405-1973
US

V. Phone/Fax

Practice location:
  • Phone: 330-750-1333
  • Fax: 330-750-0203
Mailing address:
  • Phone: 330-750-1333
  • Fax: 330-750-0203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50002410
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: