Provider Demographics
NPI:1922047190
Name:BAIN, ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:BAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 LENNON LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2485
Mailing Address - Country:US
Mailing Address - Phone:925-296-7156
Mailing Address - Fax:925-296-7174
Practice Address - Street 1:115 LA CASA VIA
Practice Address - Street 2:SUITE 202
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3042
Practice Address - Country:US
Practice Address - Phone:925-296-7156
Practice Address - Fax:925-296-7174
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA603682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A6036812Medicare PIN
CA00A6036813Medicare PIN
CA00A6036820Medicare PIN
CA00A603687Medicare PIN
CA00A603688Medicare PIN
CAG91357Medicare UPIN
CA00A6036814Medicare PIN
CA00A6036819Medicare PIN
CA00A603682Medicare PIN
CA00A603683Medicare PIN
CA00A6036811Medicare PIN
CA00A603686Medicare PIN
CA300110270Medicare PIN
CA00A6036815Medicare PIN
CA00A6036817Medicare PIN
CA00A603689Medicare PIN
CA00A6036818Medicare PIN
CA00A603685Medicare PIN
CA00A6036810Medicare PIN
CA00A603684Medicare PIN
CA300124996Medicare PIN
CA00A603680Medicare PIN
CA00A6036821Medicare PIN