Provider Demographics
NPI:1205839461
Name:BAINES, BRYAN N (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:N
Last Name:BAINES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 OMNI BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4430
Mailing Address - Country:US
Mailing Address - Phone:757-232-8777
Mailing Address - Fax:757-232-8875
Practice Address - Street 1:13347 WARWICK BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-5601
Practice Address - Country:US
Practice Address - Phone:757-877-0214
Practice Address - Fax:757-875-0524
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2021-03-19
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
VA0101043474207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0102080OtherUNITED HEALTHCARE PROV. #
VA233398OtherMAMSI PROVIDER NUMBER
VA5623014Medicaid
VA250460OtherANTHEM PROVIDER NUMBER
VA080105932OtherRAILROAD MEDICARE
VA0102080OtherUNITED HEALTHCARE PROV. #
VA080105932OtherRAILROAD MEDICARE