Provider Demographics
NPI:1629094503
Name:BAILEY, PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
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 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 604
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-5892
Mailing Address - Fax:585-756-0169
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 604
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-5892
Practice Address - Fax:585-756-0169
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143246207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0189393590OtherBLUE CHOICE GROUP #
NY00046080501OtherUNIVERA PROVIDER#
NY00372225Medicaid
NY5399029OtherGHI #
NY000912486001OtherBS WNY ID#
NY01923266Medicaid
NY7995191OtherAETNA PROVIDER #
NY143246-7WOtherWORKER'S COMP#
NY2222OtherBLUE SHIELD GROUP #
NYMDE164OtherPREFERRED CARE #
NY161535AMedicare ID - Type UnspecifiedGROUP MEDICARE 3
NY0189393590OtherBLUE CHOICE GROUP #