Provider Demographics
NPI:1194085399
Name:BAIN, CARISSA (MD)
Entity type:Individual
Prefix:DR
First Name:CARISSA
Middle Name:
Last Name:BAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:246 REGIMENTAL DR
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:NC
Mailing Address - Zip Code:28326-5508
Mailing Address - Country:US
Mailing Address - Phone:407-456-2150
Mailing Address - Fax:
Practice Address - Street 1:246 REGIMENTAL DR
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:NC
Practice Address - Zip Code:28326-5508
Practice Address - Country:US
Practice Address - Phone:407-456-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program