Provider Demographics
NPI:1851892319
Name:MCGLOIN, BAILEY ALEXANDRA (MSPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:ALEXANDRA
Last Name:MCGLOIN
Suffix:
Gender:F
Credentials:MSPAS, PA-C
Other - Prefix:
Other - First Name:BAILEY
Other - Middle Name:ALEXANDRA
Other - Last Name:AMOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 MORGAN HWY STE 4
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-2641
Mailing Address - Country:US
Mailing Address - Phone:570-344-3788
Mailing Address - Fax:
Practice Address - Street 1:5 MORGAN HWY STE 4
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508
Practice Address - Country:US
Practice Address - Phone:570-344-3788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058956363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103508620-0001Medicaid
PA652253OtherMEDICARE