Provider Demographics
NPI:1477592574
Name:MCCORKLE, BARRY S (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:S
Last Name:MCCORKLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7575 HUNTINGTON PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-5618
Mailing Address - Country:US
Mailing Address - Phone:614-987-5620
Mailing Address - Fax:937-208-8895
Practice Address - Street 1:1222 S PATTERSON BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-2684
Practice Address - Country:US
Practice Address - Phone:937-208-8885
Practice Address - Fax:937-208-8895
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.058581207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0823952Medicaid
OHH064570Medicare PIN
OH0823952Medicaid
E76456Medicare UPIN