Provider Demographics
NPI:1245200732
Name:BAIOCCHI, GARY ALAN (DO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ALAN
Last Name:BAIOCCHI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 820933
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0933
Mailing Address - Country:US
Mailing Address - Phone:215-482-2412
Mailing Address - Fax:215-487-1251
Practice Address - Street 1:525 JAMESTOWN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1751
Practice Address - Country:US
Practice Address - Phone:215-482-2412
Practice Address - Fax:215-487-1251
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PA0S005465L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA597586OtherMEDICARE GROUP TPI
PA694OtherBRAVO HEALTH
PAP519014OtherOXFORD
PA001307263Medicaid
PA080100922OtherRAIL ROAD MEDICARE
PA5602292OtherAETNA PPO
PA613144OtherCOVENTRY HEALTH AMERICA
PA0001665OtherAETNA HMO
PA1079018OtherKEYSTONE MERCY HEALTH PLA
PA415254OtherHIGHMARK BLUE SHIELD
PA0058558000OtherINDEPENDENCE BLUE CROSS
PA0098182102OtherAMERICHOICE
PA2Y0373OtherHEALTH NET
PACD4829OtherRAILROAD MEDICARE TPI
PA415254Medicare PIN
PA0058558000OtherINDEPENDENCE BLUE CROSS