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General NPI Number Information
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NPI Number | 1801883384
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Entity Type | Individual
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Provider Name | DOMINIQUE C BAILEY MD, FAAP
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Gender | Female
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Dates
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Enumeration Date | 09/30/2005
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Last Update Date | 07/31/2023
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Provider Practice Location Address
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Address Line | 2401 NORTHAMPTON ST STE 210
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City | EASTON
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State | PA
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Zip | 18045-2764
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Country | US
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Telephone | 484-591-7470
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Fax |
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Provider Business Mailing Address
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Address Line | 165 BLUE RIDGE OVERLOOK
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City | BLUE RIDGE
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State | GA
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Zip | 30513-4431
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Country | US
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Telephone | 706-946-5608
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Fax | 706-374-7628
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD76939
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD040747L
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License Number State | PA
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