Provider Demographics
NPI:1083721757
Name:MAYBERRY, BARRY MARSHALL (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:MARSHALL
Last Name:MAYBERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 TRAINING CENTER RD
Mailing Address - Street 2:
Mailing Address - City:HILLSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24343-5149
Mailing Address - Country:US
Mailing Address - Phone:276-728-3121
Mailing Address - Fax:276-728-1130
Practice Address - Street 1:160 TRAINING CENTER RD
Practice Address - Street 2:
Practice Address - City:HILLSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24343-5149
Practice Address - Country:US
Practice Address - Phone:276-728-3121
Practice Address - Fax:276-728-1130
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032468207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010058180Medicaid
VA010058180Medicaid
VAB09181Medicare UPIN