Provider Demographics
NPI:1962590133
Name:NITSCH, BARBARA ANN (MD)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:ANN
Last Name:NITSCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2618 PLAYERS CT
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6296
Mailing Address - Country:US
Mailing Address - Phone:561-389-8229
Mailing Address - Fax:
Practice Address - Street 1:2618 PLAYERS CT
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6296
Practice Address - Country:US
Practice Address - Phone:561-389-8229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2010-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME617722085R0202X
NC98017292085R0202X
AZ348552085R0202X
CO375132085R0202X
GA0561572085R0202X
OH0807002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373877900Medicaid
FLF46464Medicare UPIN
FL18338ZMedicare ID - Type Unspecified