Provider Demographics
NPI:1184642100
Name:BATES, GAYLE CATHERINE (MD)
Entity Type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:CATHERINE
Last Name:BATES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2195 EUCLID AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-3655
Mailing Address - Country:US
Mailing Address - Phone:276-669-5179
Mailing Address - Fax:276-466-8870
Practice Address - Street 1:2195 EUCLID AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3655
Practice Address - Country:US
Practice Address - Phone:276-669-5179
Practice Address - Fax:276-466-8870
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27136208000000X
VA0101241446208000000X
KY41477208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVAA101761Medicare PIN