Provider Demographics
NPI:1114910338
Name:BAILEY, CAROLYN MAY (DO FACOFP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:MAY
Last Name:BAILEY
Suffix:
Gender:F
Credentials:DO FACOFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PRESTIGE PL
Mailing Address - Street 2:SUITE 550
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3794
Mailing Address - Country:US
Mailing Address - Phone:937-752-2305
Mailing Address - Fax:937-522-7513
Practice Address - Street 1:1625 S ALEX RD
Practice Address - Street 2:
Practice Address - City:WEST CARROLLTON
Practice Address - State:OH
Practice Address - Zip Code:45449-5404
Practice Address - Country:US
Practice Address - Phone:937-865-0534
Practice Address - Fax:937-865-0721
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34001443208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000022354OtherANTHEM
0120385OtherUNITED HEALTHCARE
OH0370638Medicaid
OH000000022354OtherANTHEM
0120385OtherUNITED HEALTHCARE
A68378Medicare UPIN