Provider Demographics
NPI:1285712810
Name:BARRY, LINDA K (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:K
Last Name:BARRY
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 1:263 FARMINGTON AVE
Mailing Address - Street 2:DEPARTMENT OF SURGERY
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-3955
Mailing Address - Country:US
Mailing Address - Phone:860-679-4801
Mailing Address - Fax:860-679-1847
Practice Address - Street 1:263 FARMINGTON AVE
Practice Address - Street 2:DEPARTMENT OF SURGERY
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-3955
Practice Address - Country:US
Practice Address - Phone:860-679-4801
Practice Address - Fax:860-679-1847
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT049150208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1285712810Medicaid
CTD400030395Medicare PIN
I15108Medicare UPIN