Provider Demographics
NPI:1104856525
Name:BAIN, KATHLEEN S (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:S
Last Name:BAIN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:12 HIGH ST
Mailing Address - Street 2:STE 301
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7676
Mailing Address - Country:US
Mailing Address - Phone:207-795-5730
Mailing Address - Fax:207-795-5749
Practice Address - Street 1:12 HIGH ST
Practice Address - Street 2:STE 301
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7676
Practice Address - Country:US
Practice Address - Phone:207-795-5730
Practice Address - Fax:207-795-5749
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2013-07-10
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Provider Licenses
StateLicense IDTaxonomies
MEMD19691208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics