Basic Information
| Provider Information | |||||||||
| NPI: | 1174577142 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAILEY | ||||||||
| FirstName: | LUNA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2520 ABERDEEN BLVD | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280540635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048688400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2520 ABERDEEN BLVD | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280540635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048688400 | ||||||||
| FaxNumber: | 7048688400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 07/02/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 202212868 | SC | N | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 200401468 | NC | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | GP4146 | 05 | SC | MEDICAID | 5901043 | 05 | NC | MEDICAID |