Provider Demographics
NPI:1346246055
Name:BARRY, FREDRICK MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:FREDRICK
Middle Name:MICHAEL
Last Name:BARRY
Suffix:
Gender:M
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:PO BOX 3763
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24143-3763
Mailing Address - Country:US
Mailing Address - Phone:540-731-0907
Mailing Address - Fax:540-633-0135
Practice Address - Street 1:200 8TH ST
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-2426
Practice Address - Country:US
Practice Address - Phone:540-731-0907
Practice Address - Fax:540-633-0135
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101032539207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B60146Medicare UPIN