Provider Demographics
NPI:1407008782
Name:BAINS, PUNEETPAL S (MD)
Entity type:Individual
Prefix:
First Name:PUNEETPAL
Middle Name:S
Last Name:BAINS
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:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:803 FARSON ST STE 100
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-0016
Practice Address - Country:US
Practice Address - Phone:740-423-3640
Practice Address - Fax:740-423-3641
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.098437207RE0101X, 207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0058287Medicaid
OHP01680111OtherRAILROAD MEDICARE MHCPI
OHH054644Medicare PIN
OH0058287Medicaid