Individual
EVAN P BAILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
55 LAKE AVE N, PEDIATRIC PULMONOLOGY, WORCESTER, MA 01655-0002
(508) 856-4155
(508) 856-2609
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
(800) 225-8885
(508) 334-1977
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
247765
MA
2080P0214X
Pediatric Pulmonology Physician
Primary
247765
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110093403A
—
MA
01
—
S400154811
MEDICARE
MA
Enumeration date
06/27/2008
Last updated
11/09/2020
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