Provider Demographics
NPI:1588056030
Name:BARRY, MARY C (PA)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:C
Last Name:BARRY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:C
Other - Last Name:CORRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:24050 COMMERCE PARK
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5833
Mailing Address - Country:US
Mailing Address - Phone:877-896-9301
Mailing Address - Fax:216-896-9302
Practice Address - Street 1:444 MERRICK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2460
Practice Address - Country:US
Practice Address - Phone:516-872-2150
Practice Address - Fax:516-872-2151
Is Sole Proprietor?:No
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002344-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant