Provider Demographics
NPI:1518961150
Name:BARR, MICHAEL STUART (MD, MBA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:STUART
Last Name:BARR
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 OLD MAPLE CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-1768
Mailing Address - Country:US
Mailing Address - Phone:410-480-8365
Mailing Address - Fax:
Practice Address - Street 1:5450 KNOLL NORTH DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2373
Practice Address - Country:US
Practice Address - Phone:410-964-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054277207R00000X
DCMD035761207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD240767ZADTMedicare PIN
MDS732678XMedicare ID - Type Unspecified
MDF63556Medicare UPIN