Provider Demographics
NPI:1912082934
Name:BAINBRIDGE, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:BAINBRIDGE
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 1:501 S WHITE ST
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:MT PLEASANT
Mailing Address - State:IA
Mailing Address - Zip Code:52641-2600
Mailing Address - Country:US
Mailing Address - Phone:319-385-6700
Mailing Address - Fax:319-385-6703
Practice Address - Street 1:501 S WHITE ST
Practice Address - Street 2:SUITE ONE
Practice Address - City:MT PLEASANT
Practice Address - State:IA
Practice Address - Zip Code:52641-2600
Practice Address - Country:US
Practice Address - Phone:319-385-6700
Practice Address - Fax:319-385-6703
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26775207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1071746Medicaid
IA08011Medicare PIN
IAF02140Medicare UPIN