Provider Demographics
NPI:1710303144
Name:BAIN, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:BAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 72993
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:KY
Mailing Address - Zip Code:41072-0993
Mailing Address - Country:US
Mailing Address - Phone:859-415-2862
Mailing Address - Fax:859-415-2863
Practice Address - Street 1:835 MONROE ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41071-2062
Practice Address - Country:US
Practice Address - Phone:859-415-2862
Practice Address - Fax:859-415-2863
Is Sole Proprietor?:No
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant