Provider Demographics
NPI:1154362457
Name:BARRY, HENRY CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:CHARLES
Last Name:BARRY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:804 SERVICE RD ROOM B100
Mailing Address - Street 2:DEPARTMENT OF FAMILY MEDICINE
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-1313
Mailing Address - Country:US
Mailing Address - Phone:517-884-0429
Mailing Address - Fax:
Practice Address - Street 1:804 SERVICE RD
Practice Address - Street 2:ROOM A142
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-1313
Practice Address - Country:US
Practice Address - Phone:517-353-3050
Practice Address - Fax:517-432-3742
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301046257207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2573470Medicaid
MI1154362457Medicaid
MI1154362457Medicaid
MI0C36088012Medicare PIN