Provider Demographics
NPI:1427045285
Name:BAILER, WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:BAILER
Suffix:
Gender:M
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 2812
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-6812
Mailing Address - Country:US
Mailing Address - Phone:740-633-6504
Mailing Address - Fax:740-633-6514
Practice Address - Street 1:92 N 4TH ST
Practice Address - Street 2:SUITE 14
Practice Address - City:MARTINS FERRY
Practice Address - State:OH
Practice Address - Zip Code:43935-1691
Practice Address - Country:US
Practice Address - Phone:740-633-6504
Practice Address - Fax:740-635-6514
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18596208600000X
OH35070121B208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0274644Medicaid
WV0126514000Medicaid
OH0274644Medicaid
OH0809343Medicare PIN
WV0809345Medicare PIN
020034274Medicare PIN