Provider Demographics
NPI:1215092580
Name:BARR, SUDIPA (MD)
Entity type:Individual
Prefix:
First Name:SUDIPA
Middle Name:
Last Name:BARR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 BAIRD RD STE C
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-1247
Mailing Address - Country:US
Mailing Address - Phone:585-310-7425
Mailing Address - Fax:585-310-7428
Practice Address - Street 1:2828 BAIRD RD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-1247
Practice Address - Country:US
Practice Address - Phone:585-310-7425
Practice Address - Fax:585-310-7428
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084974208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2706825Medicaid
OHBA7361991Medicare PIN
OHI66117Medicare UPIN