Provider Demographics
NPI:1235152620
Name:WILEN, BARRY LOWELL (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:LOWELL
Last Name:WILEN
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 1:17075 DEVONSHIRE ST STE 306
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-5417
Mailing Address - Country:US
Mailing Address - Phone:818-831-3227
Mailing Address - Fax:818-831-3447
Practice Address - Street 1:17075 DEVONSHIRE ST STE 306
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-5417
Practice Address - Country:US
Practice Address - Phone:818-831-3227
Practice Address - Fax:818-831-3447
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA557812085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA055781OtherSTATE LICENSE
CAA055781OtherSTATE LICENSE