Provider Demographics
NPI:1033102074
Name:BARRY, CHARISH L (MD)
Entity Type:Individual
Prefix:
First Name:CHARISH
Middle Name:L
Last Name:BARRY
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 1:510 W PUEBLO ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-4230
Mailing Address - Country:US
Mailing Address - Phone:805-845-1221
Mailing Address - Fax:805-845-1224
Practice Address - Street 1:510 W PUEBLO ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105
Practice Address - Country:US
Practice Address - Phone:805-845-1221
Practice Address - Fax:805-845-1224
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72798208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA72798AMedicare ID - Type Unspecified
CA123060Medicare UPIN