Provider Demographics
NPI:1194711150
Name:DICK, BARRY L (MD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:L
Last Name:DICK
Suffix:
Gender:M
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 1:2300 CHAMBER CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAKESIDE PARK
Mailing Address - State:KY
Mailing Address - Zip Code:41017-1673
Mailing Address - Country:US
Mailing Address - Phone:859-344-5555
Mailing Address - Fax:859-344-5552
Practice Address - Street 1:580 S LOOP RD
Practice Address - Street 2:SUITE 201
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3415
Practice Address - Country:US
Practice Address - Phone:859-344-1600
Practice Address - Fax:859-344-0091
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY296042086S0129X, 174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No174400000XOther Service ProvidersSpecialist
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100056850Medicaid
IN100354170Medicaid
KYP01058472OtherRAILROAD MEDICARE
OH0915148Medicaid
P00252704OtherRAILROAD MEDICARE
KY64933096Medicaid
KY3400183Medicare PIN
OH0915148Medicaid
OHH098240Medicare PIN
KYK044910Medicare PIN
KYP01058472OtherRAILROAD MEDICARE
F52005Medicare UPIN
P00252704OtherRAILROAD MEDICARE
KY7100056850Medicaid
IN100354170Medicaid
OH770000337Medicare PIN
P00264688Medicare PIN