Provider Demographics
NPI:1316936073
Name:BAIN, SEAN R (MD)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:R
Last Name:BAIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 PARK STREET
Mailing Address - Street 2:GLENS FALLS HOSPITAL - CREDENTIALING
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4413
Mailing Address - Country:US
Mailing Address - Phone:518-926-5925
Mailing Address - Fax:518-926-5917
Practice Address - Street 1:100 PARK ST
Practice Address - Street 2:GLENS FALLS HOSPITAL
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4413
Practice Address - Country:US
Practice Address - Phone:518-926-5918
Practice Address - Fax:518-926-5917
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2021-08-30
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Provider Licenses
StateLicense IDTaxonomies
NY206924208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00148627OtherRR MEDICARE
NY01809049Medicaid
NY01809049Medicaid
NYRA4676Medicare PIN