Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 200301320 | NC |
NPI | 1053510529 |
---|---|
Provider Name | Dr. Frederique C Bailliard |
First Address | Raleigh, NC 27607-7507 |
Second Address | Raleigh, NC 27607-7507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2007 |
Last Update Date | 11/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5910173 | (05) | ND |
5920625 | (05) | NC |