Provider Demographics
NPI:1972503357
Name:BAILEY, LINDA ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:ELLEN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3170 KETTERING BLVD
Mailing Address - Street 2:BUILDING B 3RD FLOOR
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1924
Mailing Address - Country:US
Mailing Address - Phone:937-991-3188
Mailing Address - Fax:937-223-9811
Practice Address - Street 1:244 WILSON DR
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-1864
Practice Address - Country:US
Practice Address - Phone:937-372-8632
Practice Address - Fax:937-341-8899
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047861208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0536094Medicaid
OHH278430Medicare PIN
OHA15517Medicare UPIN
OH0537294Medicare PIN
OHBA0537295Medicare ID - Type Unspecified