Provider Demographics
NPI:1154386670
Name:BARRY, MARY G (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:G
Last Name:BARRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-272-5100
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:825 BARRET AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1743
Practice Address - Country:US
Practice Address - Phone:502-540-7200
Practice Address - Fax:502-540-7207
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25092207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00000050959OtherANTHEM / NCMA
KY110139124OtherRAILROAD MEDICARE
KY1054765OtherPASSPORT / NCMA
KY000026447DOtherHUMANA / NCMA
KY008914OtherSIHO / NCMA
KY2433720000OtherPASSPORT ADVANTAGE / NCMA
KY64250921Medicaid
IN100360820Medicaid
KY64250921Medicaid
KY0361907Medicare PIN