Healthcare Provider Details

I. General information

NPI: 1104809805
Provider Name (Legal Business Name): RICHARD MORGAN BAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PERRYRIDGE RD
GREENWICH CT
06830-4697
US

IV. Provider business mailing address

5 PERRYRIDGE RD
GREENWICH CT
06830-4697
US

V. Phone/Fax

Practice location:
  • Phone: 203-863-3000
  • Fax:
Mailing address:
  • Phone: 203-863-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number200501322
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2005-01322
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: