Provider Demographics
NPI:1588746234
Name:BAIN, JESSE C (DO)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:C
Last Name:BAIN
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Gender:M
Credentials:DO
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Mailing Address - Street 1:PO BOX 91734
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-1734
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:1250 E MARSHALL ST
Practice Address - Street 2:PEDIATRICS
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5051
Practice Address - Country:US
Practice Address - Phone:804-828-4080
Practice Address - Fax:804-628-2138
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2013-08-29
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Provider Licenses
StateLicense IDTaxonomies
VA01022034852080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine