Provider Demographics
NPI:1417995275
Name:BARASCH, EUGENE (MD)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:
Last Name:BARASCH
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 243
Mailing Address - Street 2:
Mailing Address - City:N FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02556-0243
Mailing Address - Country:US
Mailing Address - Phone:508-563-1311
Mailing Address - Fax:
Practice Address - Street 1:118 WILD HARBOR RD
Practice Address - Street 2:N. FALMOUTH
Practice Address - City:N FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02556-2304
Practice Address - Country:US
Practice Address - Phone:508-563-1311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0369302085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2018845Medicaid
MA2018845Medicaid
MAE37276Medicare UPIN
MAA31976Medicare ID - Type Unspecified