Provider Demographics
NPI:1033214002
Name:BARR, MARY L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:L
Last Name:BARR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 ARCH STREET
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790
Mailing Address - Country:US
Mailing Address - Phone:607-729-2121
Mailing Address - Fax:607-798-7751
Practice Address - Street 1:41 ARCH STREET
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790
Practice Address - Country:US
Practice Address - Phone:607-729-2121
Practice Address - Fax:607-798-7751
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004524363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS42566Medicare UPIN
NYBB0322Medicare ID - Type Unspecified