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NPI Code Detail

MEDICARE: BAIN DERMATOLOGY, P.A.

MEDICARE: BAIN DERMATOLOGY, P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207ND0101XMOHS-Micrographic Surgery Physician2013-02484NC

General Provider Information

NPI Number : 1740691674
Entity Type Code : Organization
Provider Name (Legal Business Name) : BAIN DERMATOLOGY, P.A.
Provider Business Mailing Address
First Line : 7200 CREEDMOOR RD
Second Line : SUITE 104
City : RALEIGH
State : NC
Zip : 27613-1710
Country : US
Telephone Number : 919-518-0999
Fax Number : 919-518-0939
Provider Business Practice Location Address
First Line : 7200 CREEDMOOR RD
Second Line : SUITE 104
City : RALEIGH
State : NC
Zip : 27613-1710
Country : US
Telephone Number : 919-518-0999
Fax Number : 919-518-0939
Authorized Official
Title or Position : OWNER/PHYSICIAN
Name : DR. EARL EUGENE BAIN III
Credential : M.D.
Telephone Number : 919-518-0999
Provider Enumeration Date : 05/14/2014
Last Update Date : 09/19/2014

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