Provider Demographics
NPI:1598957177
Name:BAILLIE, DANIEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:BAILLIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:240 CETRONIA RD
Mailing Address - Street 2:SUITE 200N
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9263
Mailing Address - Country:US
Mailing Address - Phone:610-628-8080
Mailing Address - Fax:215-529-4685
Practice Address - Street 1:240 CETRONIA RD
Practice Address - Street 2:SUITE 200N
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9263
Practice Address - Country:US
Practice Address - Phone:610-628-8080
Practice Address - Fax:215-529-4685
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD440880208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102533234Medicaid
PA102533234Medicaid