Provider Demographics
NPI:1124139662
Name:WELLS, BARRY H (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:H
Last Name:WELLS
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 483
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-0483
Mailing Address - Country:US
Mailing Address - Phone:410-703-7300
Mailing Address - Fax:
Practice Address - Street 1:1905 KINGSWOOD CT
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2945
Practice Address - Country:US
Practice Address - Phone:410-703-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD33084208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD340010755OtherRAILROAD MEDICARE #
MD2564OtherBLUECHOICE MARYLAND #
MD232991300Medicaid
MD0W03BHOtherCAREFIRST MARYLAND #
MD2564OtherBLUECHOICE MARYLAND #
MD340010755OtherRAILROAD MEDICARE #