Provider Demographics
NPI:1104800812
Name:BARTON, PAUL R
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:BARTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 LOGAN AVE
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:PA
Mailing Address - Zip Code:16686-1522
Mailing Address - Country:US
Mailing Address - Phone:814-684-4334
Mailing Address - Fax:814-684-4414
Practice Address - Street 1:1010 LOGAN AVE
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:PA
Practice Address - Zip Code:16686-1522
Practice Address - Country:US
Practice Address - Phone:814-684-4334
Practice Address - Fax:814-684-4414
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2011-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003474L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2154OtherEISINGER HEALTH PLAN
NY1036225OtherGATEWAY HEALTH PLAN
PA211201OtherUPMC HEALTH PLAN
PA709978OtherBLUE SHIELD
PA0012452130005Medicaid
PA65343OtherMEDPLUS THREE RIVERS HEAL
TX0528847OtherAETNA
TX0528847OtherAETNA
PA2154OtherEISINGER HEALTH PLAN
PA674743Medicare ID - Type Unspecified