Provider Demographics
NPI:1134101199
Name:BARROW, MARK EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EDWARD
Last Name:BARROW
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 1:770 PINE STREET
Mailing Address - Street 2:SUITE 290
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-7516
Mailing Address - Country:US
Mailing Address - Phone:478-751-5825
Mailing Address - Fax:478-755-1332
Practice Address - Street 1:770 PINE STREET
Practice Address - Street 2:SUITE 290
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7516
Practice Address - Country:US
Practice Address - Phone:478-751-5825
Practice Address - Fax:478-755-1332
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0446232085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000871384CMedicaid
GA000871384CMedicaid
H17560Medicare UPIN
GA30BDLMPMedicare PIN
GA30BDLMRMedicare PIN