Provider Demographics
NPI:1376509281
Name:BARTH, MARY JANE T (MD)
Entity Type:Individual
Prefix:
First Name:MARY JANE
Middle Name:T
Last Name:BARTH
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:1501 N CAMPBELL AVE
Mailing Address - Street 2:DEPARTMENT OF SURGERY SUITE 4302
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724-5071
Mailing Address - Country:US
Mailing Address - Phone:520-626-9752
Mailing Address - Fax:520-626-4042
Practice Address - Street 1:1501 N CAMPBELL AVE
Practice Address - Street 2:DEPARTMENT OF SURGERY SUITE 4302
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-5071
Practice Address - Country:US
Practice Address - Phone:520-626-9752
Practice Address - Fax:520-626-4042
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036090133208G00000X
AZ51254208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200224770AMedicaid