Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD073149L | PA |
Y | 2080P0207X | Pediatric Hematology-Oncologist | MD073149L | PA |
NPI | 1134153612 |
---|---|
Provider Name | Leonard Charles Bailey |
First Address | Philadelphia, PA 19107-3323 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 15/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0035785 | (05) | NJ |
101105574 | (05) | PA |
I08511 | (02) |