Provider Demographics
NPI:1376849950
Name:BARRETT, GARY SETH (PA)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:SETH
Last Name:BARRETT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10210 COULOAK DR
Practice Address - Street 2:STE E
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-7679
Practice Address - Country:US
Practice Address - Phone:704-801-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05725363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1376849950Medicaid
TN1522614Medicaid
SC2373PAMedicaid
TNP01418106OtherRR MEDICARE
NCNCQ079CMedicare PIN
TN103I977365Medicare PIN
TN1522614Medicaid
SC2373PAMedicaid
TNP01418106OtherRR MEDICARE
NCNCQ079BMedicare PIN