Provider Demographics
NPI:1174537898
Name:BAIN, FRANCIS JEROME-XAVIER (MD)
Entity type:Individual
Prefix:
First Name:FRANCIS
Middle Name:JEROME-XAVIER
Last Name:BAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 ALPS RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3635
Mailing Address - Country:US
Mailing Address - Phone:973-628-8500
Mailing Address - Fax:973-628-7944
Practice Address - Street 1:1500 ALPS RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3635
Practice Address - Country:US
Practice Address - Phone:973-628-8500
Practice Address - Fax:973-628-7944
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA37891207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC54973Medicare UPIN