Healthcare Provider Details

I. General information

NPI: 1972601235
Provider Name (Legal Business Name): BIMAL P JAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LYNNFIELD ST
LYNN MA
01904
US

IV. Provider business mailing address

500 LYNNFIELD ST
LYNN MA
01904
US

V. Phone/Fax

Practice location:
  • Phone: 781-595-3366
  • Fax:
Mailing address:
  • Phone: 781-595-3366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number58508
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: