Provider Demographics
NPI:1669548731
Name:BRIAN S BAYLY MD & ASSOCIATES PA
Entity type:Organization
Organization Name:BRIAN S BAYLY MD & ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CORPORATE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:BAYLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-220-0031
Mailing Address - Street 1:7223 HANOVER PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2023
Mailing Address - Country:US
Mailing Address - Phone:301-220-0031
Mailing Address - Fax:301-220-2240
Practice Address - Street 1:7223 HANOVER PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2023
Practice Address - Country:US
Practice Address - Phone:301-220-0031
Practice Address - Fax:301-220-2240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD910751700Medicaid
6102OtherCAREFIRST
MDB770001124OtherRAILROAD MEDICARE
MD910751700Medicaid