Provider Demographics
NPI:1245358274
Name:BAILEY, SUSAN LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:LYNN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:LYNN
Other - Last Name:SAVAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-368-3919
Mailing Address - Fax:718-228-8124
Practice Address - Street 1:700 COMMONS WAY
Practice Address - Street 2:#227
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-3147
Practice Address - Country:US
Practice Address - Phone:404-307-6624
Practice Address - Fax:718-228-8124
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264842207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03535311Medicaid
NY03535311Medicaid
GAE69333Medicare UPIN
NYJ400118722/GP BA0017Medicare PIN