Provider Demographics
NPI:1255485256
Name:BARRESI, MARY LYNN (DO)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LYNN
Last Name:BARRESI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-2123
Mailing Address - Country:US
Mailing Address - Phone:502-561-7000
Mailing Address - Fax:502-568-1015
Practice Address - Street 1:825 S 6TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2123
Practice Address - Country:US
Practice Address - Phone:502-561-7000
Practice Address - Fax:502-568-1015
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02573207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine