Provider Demographics
NPI:1255316030
Name:BAYLOR, KATHY EILEEN (MD)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:EILEEN
Last Name:BAYLOR
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:PO BOX 919
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-0919
Mailing Address - Country:US
Mailing Address - Phone:570-387-2144
Mailing Address - Fax:
Practice Address - Street 1:695 E 16TH ST STE B
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-2320
Practice Address - Country:US
Practice Address - Phone:570-759-2203
Practice Address - Fax:570-759-2253
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD051777L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG74279Medicare UPIN
PA011397Medicare ID - Type Unspecified