Provider Demographics
NPI: | 1164468393 |
---|---|
Name: | BARCLAY, JAMES C (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | JAMES |
Middle Name: | C |
Last Name: | BARCLAY |
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: | 2110 LEITER RD |
Mailing Address - Street 2: | |
Mailing Address - City: | MIAMISBURG |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 45342-3660 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 937-253-6448 |
Mailing Address - Fax: | 934-253-5971 |
Practice Address - Street 1: | 5350 LAMME RD |
Practice Address - Street 2: | |
Practice Address - City: | MORAINE |
Practice Address - State: | OH |
Practice Address - Zip Code: | 45439-3215 |
Practice Address - Country: | US |
Practice Address - Phone: | 937-534-4632 |
Practice Address - Fax: | 937-534-4609 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-06-22 |
Last Update Date: | 2008-07-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OH | 35-075005 | 2084P0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 000000391334 | Other | ANTHEM |
OH | 2129397 | Medicaid | |
OH | 265907000 | Other | MAGELLAN |
OH | $$$$$$$$$00 | Other | BWC |
OH | $$$$$$$$$004 | Other | MMOH |
OH | 000000391334 | Other | ANTHEM |
OH | $$$$$$$$$00 | Other | BWC |