Provider Demographics
NPI:1699916528
Name:BARLATT, CRISPIN OLUKEMI (DO)
Entity type:Individual
Prefix:
First Name:CRISPIN
Middle Name:OLUKEMI
Last Name:BARLATT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4694 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:OH
Mailing Address - Zip Code:44505
Mailing Address - Country:US
Mailing Address - Phone:330-480-7655
Mailing Address - Fax:330-759-3851
Practice Address - Street 1:4694 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1012
Practice Address - Country:US
Practice Address - Phone:330-480-7655
Practice Address - Fax:330-759-3851
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH010638207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH170590OtherMEDICARE PTAN
OH0081750Medicaid