Provider Demographics
NPI:1881766095
Name:BAILEY WALLACE, GAIL MARIA (MD)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:MARIA
Last Name:BAILEY WALLACE
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 1:95 GRASSLANDS RD
Mailing Address - Street 2:DEPT OF MEDICINE MUNGER PAVILION
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1652
Mailing Address - Country:US
Mailing Address - Phone:914-594-4388
Mailing Address - Fax:914-594-4434
Practice Address - Street 1:95 GRASSLANDS RD NEW YORK MEDICAL COLLEGE
Practice Address - Street 2:DEPT OF MEDICINE MUNGER PAVILIAN
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595
Practice Address - Country:US
Practice Address - Phone:914-594-4388
Practice Address - Fax:914-594-4434
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201740207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY755AG1OtherEMPIRE BCBS#
NY00832779Medicaid
NY755AG1OtherEMPIRE BCBS#
NY00832779Medicaid