Provider Demographics
NPI:1255392643
Name:BAYLISS, E VIRGINIA (MD)
Entity type:Individual
Prefix:
First Name:E VIRGINIA
Middle Name:
Last Name:BAYLISS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 HANSEN RD STE 103
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8839
Mailing Address - Country:US
Mailing Address - Phone:434-602-1477
Mailing Address - Fax:434-296-1195
Practice Address - Street 1:154 HANSEN RD STE 103
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8839
Practice Address - Country:US
Practice Address - Phone:434-602-1477
Practice Address - Fax:434-296-1195
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010402512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
D80400Medicare UPIN
190001260Medicare ID - Type Unspecified