Provider Demographics
NPI:1770039174
Name:BAILEY, REBECCA (PA-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:MAHONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:819 WORCESTER ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01151-1056
Mailing Address - Country:US
Mailing Address - Phone:413-304-2501
Mailing Address - Fax:413-789-0290
Practice Address - Street 1:305A MAPLE STREET
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028
Practice Address - Country:US
Practice Address - Phone:413-304-2501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA5803363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical