Provider Demographics
NPI:1861606642
Name:DAVID A BAILEN MD PC
Entity type:Organization
Organization Name:DAVID A BAILEN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAILEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-267-4520
Mailing Address - Street 1:720 HARRISON AVE
Mailing Address - Street 2:SUITE 506
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2371
Mailing Address - Country:US
Mailing Address - Phone:617-638-8134
Mailing Address - Fax:617-638-8115
Practice Address - Street 1:720 HARRISON AVE
Practice Address - Street 2:SUITE 506
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2371
Practice Address - Country:US
Practice Address - Phone:617-638-8134
Practice Address - Fax:617-638-8115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty