Provider Demographics
NPI:1306823737
Name:BARNETT-RICO, MARIAN (MD)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:BARNETT-RICO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 DARROW RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-5021
Mailing Address - Country:US
Mailing Address - Phone:330-656-9304
Mailing Address - Fax:330-656-5901
Practice Address - Street 1:27100 CHARDON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-1116
Practice Address - Country:US
Practice Address - Phone:440-585-6500
Practice Address - Fax:330-656-5901
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064229207PE0004X
OH35-064229207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000322050OtherANTHEM
OH000000381220OtherANTHEM
OH0909119Medicaid
OH000000154564OtherANTHEM
OHP00098992Medicare PIN
OHP00329890Medicare PIN
C28721Medicare UPIN
OHBA4125315Medicare PIN
OH000000322050OtherANTHEM
OHBA4125313Medicare PIN
OH0734334Medicare UPIN
OHBA4125314Medicare PIN