Provider Demographics
NPI:1437564366
Name:BAILLY, ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:BAILLY
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 1:3576 N LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ERIEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13061-3105
Mailing Address - Country:US
Mailing Address - Phone:315-662-7860
Mailing Address - Fax:315-662-7860
Practice Address - Street 1:3576 N LAKE RD
Practice Address - Street 2:
Practice Address - City:ERIEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13061-3105
Practice Address - Country:US
Practice Address - Phone:315-662-7860
Practice Address - Fax:315-662-7860
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151243-1146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY207L00000XOtherWPC