Provider Demographics
NPI:1154384964
Name:BARISH, ROBERT ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALAN
Last Name:BARISH
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 1:106 EDGEVALE RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2107
Mailing Address - Country:US
Mailing Address - Phone:410-532-2032
Mailing Address - Fax:410-706-1414
Practice Address - Street 1:655 W BALTIMORE ST
Practice Address - Street 2:ROOM 14-011
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1509
Practice Address - Country:US
Practice Address - Phone:410-706-1413
Practice Address - Fax:410-706-1414
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0032507146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH013Medicare ID - Type Unspecified
MDE15165Medicare UPIN