Provider Demographics
NPI:1699036210
Name:BAILEY, NATHANIEL WALTON (MD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:WALTON
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:PO BOX 980459
Mailing Address - Street 2:ANES: ANESTHESIOLOGY
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0459
Mailing Address - Country:US
Mailing Address - Phone:804-828-0733
Mailing Address - Fax:804-828-8682
Practice Address - Street 1:1250 E MARSHALL ST
Practice Address - Street 2:ANES: ANESTHESIOLOGY
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5051
Practice Address - Country:US
Practice Address - Phone:804-828-0733
Practice Address - Fax:804-828-8682
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program