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General NPI Number Information
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NPI Number | 1205839461
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Entity Type | Individual
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Provider Name | BRYAN N. BAINES M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 03/19/2021
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Provider Practice Location Address
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Address Line | 13347 WARWICK BLVD
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City | NEWPORT NEWS
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State | VA
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Zip | 23602-5601
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Country | US
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Telephone | 757-877-0214
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Fax | 757-875-0524
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Provider Business Mailing Address
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Address Line | 860 OMNI BLVD STE 101
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-4430
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Country | US
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Telephone | 757-232-8777
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Fax | 757-232-8875
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101043474
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License Number State | VA
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