Provider Demographics
NPI:1851440101
Name:BAINBRIDGE, LOUIS R (PA-C)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:R
Last Name:BAINBRIDGE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 HARKER RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08515
Mailing Address - Country:US
Mailing Address - Phone:609-324-0903
Mailing Address - Fax:609-298-4867
Practice Address - Street 1:1854 VETERANS HWY
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19056-2107
Practice Address - Country:US
Practice Address - Phone:215-752-1600
Practice Address - Fax:215-750-7328
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00172100363AM0700X
PAMA001037L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical