Provider Demographics
NPI:1861781510
Name:BAILEY, CHRISTOPHER ERIC (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:ERIC
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 OAK GROVE RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-2725
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DRIVE, ROOM 4520
Practice Address - Street 2:BOX 9200
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-9200
Practice Address - Country:US
Practice Address - Phone:304-293-0941
Practice Address - Fax:304-293-2902
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV25463207Y00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program