Provider Demographics
NPI:1366426157
Name:BARB, MATTHEW D (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:D
Last Name:BARB
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 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11123 PARKVIEW PLAZA DR
Practice Address - Street 2:SUITE 106
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1707
Practice Address - Country:US
Practice Address - Phone:260-672-6550
Practice Address - Fax:260-672-6559
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058845A207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000337237OtherANTHEM
IN200491340Medicaid
IN3937240021OtherMEDICARE DMEPOS
IN3937240024OtherMEDICARE DMFPOS
IN000000337241OtherANTHEM
P00160977OtherRAILROAD MEDICARE
IN15677OtherPHYSICIANS HEALTH PLAN
7482611OtherAETNA
IN138160KMedicare PIN
7482611OtherAETNA
I12296Medicare UPIN
IN000000337237OtherANTHEM
IN3937240024OtherMEDICARE DMFPOS
IN070830NMedicare PIN