Provider Demographics
NPI:1841288750
Name:BAYNE, DAVID PETER (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PETER
Last Name:BAYNE
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 1:346 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2580
Mailing Address - Country:US
Mailing Address - Phone:607-763-8101
Mailing Address - Fax:607-763-8049
Practice Address - Street 1:100 EMANCIPATION DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23667-2161
Practice Address - Country:US
Practice Address - Phone:757-722-9961
Practice Address - Fax:577-283-1597
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041430208800000X
NC31767208800000X
NY268172208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007534558Medicaid
VA007534558Medicaid
340000148Medicare PIN