Provider Demographics
NPI:1235154741
Name:BAKST, BARRY L (DO)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:L
Last Name:BAKST
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2006 FOULK RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-3644
Mailing Address - Country:US
Mailing Address - Phone:302-529-8783
Mailing Address - Fax:302-529-7470
Practice Address - Street 1:2006 FOULK RD
Practice Address - Street 2:SUITE B
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-3644
Practice Address - Country:US
Practice Address - Phone:302-529-8783
Practice Address - Fax:302-529-7470
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC200027642081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE2445310OtherCIGNA
DE510329923OtherUNITED HEALTH CARE
DE510329923OtherTRICARE
DEP3278310OtherOXFORD HEALTH PLAN
DE0000102003Medicaid
DE2008059OtherAETNA-HMO
DE4295831OtherAETNA-PPO
DE510329923OtherDEVON NETWORK
DE293733OtherMAMSI
DE0000102003OtherDE PHYSICIANS CARE
DE250008397OtherRAILROAD MEDICARE
CT44003OtherCOVENTRY
DE0091456000OtherAMERIHEALTH-HMO
DE193245OtherAMERIHEALTH-PPO
DE0091456000OtherAMERIHEALTH-HMO
CT44003OtherCOVENTRY