Provider Demographics
NPI:1336258334
Name:BAILER, ALAN S (DOCTOR OF OSTEOPATHY)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:S
Last Name:BAILER
Suffix:
Gender:M
Credentials:DOCTOR OF OSTEOPATHY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POST OFFICE BOX 230
Mailing Address - Street 2:
Mailing Address - City:CHELTENHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19012-0230
Mailing Address - Country:US
Mailing Address - Phone:215-728-9100
Mailing Address - Fax:215-728-9101
Practice Address - Street 1:1330 COTTMAN AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-3729
Practice Address - Country:US
Practice Address - Phone:215-728-9100
Practice Address - Fax:215-728-9101
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB37784207R00000X
PAOS004481L207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA152239Medicare ID - Type Unspecified
C32035Medicare UPIN