Provider Demographics
NPI:1427029347
Name:BAINBRIDGE, PETER (DO)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:BAINBRIDGE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 COSHOCTON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-1440
Mailing Address - Country:US
Mailing Address - Phone:740-393-9111
Mailing Address - Fax:740-399-3161
Practice Address - Street 1:1490 COSHOCTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-6099
Practice Address - Country:US
Practice Address - Phone:740-393-9111
Practice Address - Fax:740-399-3161
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004764207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0749391Medicaid
OHE51846Medicare UPIN
OHBA0644679Medicare ID - Type UnspecifiedMEDICARE