Provider Demographics
NPI:1619939097
Name:BAUTISTA, VIRGILIO MELECIO (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGILIO
Middle Name:MELECIO
Last Name:BAUTISTA
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 1:1102 GRANBYS RUN
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-8130
Mailing Address - Country:US
Mailing Address - Phone:410-749-4995
Mailing Address - Fax:
Practice Address - Street 1:101B MARKET ST
Practice Address - Street 2:
Practice Address - City:POCOMOKE CITY
Practice Address - State:MD
Practice Address - Zip Code:21851-1024
Practice Address - Country:US
Practice Address - Phone:410-957-6900
Practice Address - Fax:410-957-6736
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61536207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine