MEDICARE: BAILEY MARR MAHONEY PA

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1982567707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAILEY MARR MAHONEY PA

Provider Business Mailing Address
First Line	:	953 DANBY RD
Second Line	:
City	:	ITHACA
State	:	NY
Zip	:	14850-7002
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 LAKE JAMES DR STE 200
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-6780
Country	:	US
Telephone Number	:	757-523-0022
Fax Number	:

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

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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