MEDICARE: MRS. CAROLYN MAY BAILEY DO FACOFP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	34001443	OH
2	207Q00000X	Family Medicine Physician	34001443	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000022354	OTHER	OH	ANTHEM
2	0120385	OTHER		UNITED HEALTHCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114910338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLYN MAY BAILEY DO FACOFP

Provider Business Mailing Address
First Line	:	1 PRESTIGE PL
Second Line	:	SUITE 550
City	:	MIAMISBURG
State	:	OH
Zip	:	45342-3794
Country	:	US
Telephone Number	:	937-752-2305
Fax Number	:	937-522-7513

Provider Business Practice Location Address
First Line	:	1625 S ALEX RD
Second Line	:
City	:	WEST CARROLLTON
State	:	OH
Zip	:	45449-5404
Country	:	US
Telephone Number	:	937-865-0534
Fax Number	:	937-865-0721

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	09/12/2014

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