Provider Demographics
NPI:1255508883
Name:BARRY, MOHAMED K (MD)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:K
Last Name:BARRY
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 1:527 W LAFAYETTE BLVD
Mailing Address - Street 2:APT 12C
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-3100
Mailing Address - Country:US
Mailing Address - Phone:917-685-5712
Mailing Address - Fax:
Practice Address - Street 1:61 CAMPUS DR STE 104
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-7542
Practice Address - Country:US
Practice Address - Phone:304-596-5615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV29247208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery