Provider Demographics
NPI:1568480903
Name:BAILEY, R. EUGENE (MD)
Entity Type:Individual
Prefix:
First Name:R.
Middle Name:EUGENE
Last Name:BAILEY
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 1:3200 BURNET AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-2424
Mailing Address - Country:US
Mailing Address - Phone:315-433-9999
Mailing Address - Fax:315-396-0787
Practice Address - Street 1:3200 BURNET AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206-2424
Practice Address - Country:US
Practice Address - Phone:315-433-9999
Practice Address - Fax:315-396-0787
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183487207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01297185Medicaid
NY34820XMedicare PIN