Provider Demographics
NPI:1619943065
Name:BAIN, EARLE E (MD)
Entity Type:Individual
Prefix:DR
First Name:EARLE
Middle Name:E
Last Name:BAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:26102 CHERRY BLOSSOM CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-1281
Mailing Address - Country:US
Mailing Address - Phone:609-799-9374
Mailing Address - Fax:609-730-3125
Practice Address - Street 1:1125 TRENTON HARBOURTON RD
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08560-1504
Practice Address - Country:US
Practice Address - Phone:609-730-4346
Practice Address - Fax:609-730-3125
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1593112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G94529Medicare UPIN
BA A29668Medicare ID - Type Unspecified