Provider Demographics
NPI:1609952035
Name:BAIN, JUDITH A (NP)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:BAIN
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:20 RESEARCH PL STE 320
Mailing Address - Street 2:
Mailing Address - City:N CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-2455
Mailing Address - Country:US
Mailing Address - Phone:978-256-1858
Mailing Address - Fax:978-788-7890
Practice Address - Street 1:20 RESEARCH PL
Practice Address - Street 2:
Practice Address - City:N CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-2454
Practice Address - Country:US
Practice Address - Phone:978-788-7307
Practice Address - Fax:978-788-7890
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2020-11-10
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Provider Licenses
StateLicense IDTaxonomies
MA159329363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0702129Medicaid
MANP3404OtherBLUE CROSS
MANP3404Medicare ID - Type Unspecified
MAP37892Medicare UPIN