Provider Demographics
NPI:1043575145
Name:BARCZEWSKI, LAURA LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:LYNN
Last Name:BARCZEWSKI
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-912-7193
Mailing Address - Fax:859-441-2230
Practice Address - Street 1:1400 GRAND AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41071
Practice Address - Country:US
Practice Address - Phone:859-912-7193
Practice Address - Fax:859-441-2230
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY46840207Q00000X
KYR2697207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0102135Medicaid
KY7100292360Medicaid
KYK126620Medicare PIN