Provider Demographics
NPI:1720217383
Name:MAINS, TRAYTON B (DO)
Entity Type:Individual
Prefix:
First Name:TRAYTON
Middle Name:B
Last Name:MAINS
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:PO BOX 636930
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6930
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:825 W MARKET ST STE 260
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2745
Practice Address - Country:US
Practice Address - Phone:419-996-4003
Practice Address - Fax:419-996-5276
Is Sole Proprietor?:No
Enumeration Date:2009-07-03
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34012761207RR0500X
KY03663207RR0500X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100305420Medicaid
OH0106624Medicaid
KYK144910Medicare PIN