Healthcare Provider Details

I. General information

NPI: 1477006039
Provider Name (Legal Business Name): JAY D MCBAIN PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2016
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BRAMHALL ST
PORTLAND ME
04102-3134
US

IV. Provider business mailing address

22 BRAMHALL ST
PORTLAND ME
04102-3134
US

V. Phone/Fax

Practice location:
  • Phone: 207-885-9905
  • Fax: 207-396-5600
Mailing address:
  • Phone: 207-885-9905
  • Fax: 207-396-5600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1621
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: