Provider Demographics
NPI:1093737207
Name:BARTA, CHARISSE H (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARISSE
Middle Name:H
Last Name:BARTA
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 1:6124 W PARKER RD STE 432
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8124
Mailing Address - Country:US
Mailing Address - Phone:973-403-3100
Mailing Address - Fax:972-403-3105
Practice Address - Street 1:6124 W PARKER RD STE 432
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8124
Practice Address - Country:US
Practice Address - Phone:618-235-3378
Practice Address - Fax:618-235-2620
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN34822084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG71231Medicare UPIN
IL450390Medicare ID - Type Unspecified