Provider Demographics
NPI:1306959291
Name:BARRY OSTROW MD PA
Entity type:Organization
Organization Name:BARRY OSTROW MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:OSTROW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-219-3206
Mailing Address - Street 1:4908 LAKEGREEN CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-3593
Mailing Address - Country:US
Mailing Address - Phone:919-219-3206
Mailing Address - Fax:919-788-1609
Practice Address - Street 1:4908 LAKEGREEN CT
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-3593
Practice Address - Country:US
Practice Address - Phone:919-219-3206
Practice Address - Fax:919-510-0252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC64369OtherBCBS
NC8964369Medicaid
C81473Medicare UPIN
NC64369OtherBCBS