Provider Demographics
NPI:1497712277
Name:SCANLAN, BARRY ANTHONY (DO)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:ANTHONY
Last Name:SCANLAN
Suffix:
Gender:M
Credentials:DO
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 744786
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-4786
Mailing Address - Country:US
Mailing Address - Phone:704-834-2450
Mailing Address - Fax:704-671-5331
Practice Address - Street 1:600 W TRADE ST STE A
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:NC
Practice Address - Zip Code:28034-1543
Practice Address - Country:US
Practice Address - Phone:980-834-9130
Practice Address - Fax:980-834-9869
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9401016207R00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8974752Medicaid
NC8974752Medicaid
NC2205216BMedicare PIN
NC2205216CMedicare PIN
NC2205216AMedicare PIN