Provider Demographics
NPI:1235125972
Name:BARRY, NEIL G III (MD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:G
Last Name:BARRY
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:3004 CUMBERLAND AVE
Mailing Address - Street 2:MEDICAL ARTS BLDG
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-2343
Mailing Address - Country:US
Mailing Address - Phone:606-248-4162
Mailing Address - Fax:606-242-3429
Practice Address - Street 1:3004 CUMBERLAND AVE
Practice Address - Street 2:MEDICAL ARTS BLDG
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-2343
Practice Address - Country:US
Practice Address - Phone:606-248-4162
Practice Address - Fax:606-242-3429
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2022-09-26
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY25671207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64256712Medicaid
KY64256712Medicaid
KY0614601Medicare ID - Type Unspecified