Provider Demographics
NPI:1356459994
Name:RITTBERG, BARRY R (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:R
Last Name:RITTBERG
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 1:2312 S 6TH ST
Mailing Address - Street 2:SUITE F256/2B W
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1336
Mailing Address - Country:US
Mailing Address - Phone:612-273-8700
Mailing Address - Fax:
Practice Address - Street 1:2312 S 6TH ST
Practice Address - Street 2:SUITE F256/2B W
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1336
Practice Address - Country:US
Practice Address - Phone:612-273-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN290952084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8D935RIOtherBCBS MN
MNHP17039OtherHEALTHPARTNERS NUMBER
MN057580100Medicaid
IA0999540Medicaid
MN108821OtherUCARE NUMBER
MN607399OtherAMERICA'S PPO
MN1012205OtherPREFERRED ONE NUMBER
MN15-05304OtherUBH/MEDICA
MN607399OtherAMERICA'S PPO
MN8D935RIOtherBCBS MN
MN1012205OtherPREFERRED ONE NUMBER