Provider Demographics
NPI:1538281670
Name:BARTH, DAVID J (PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:BARTH
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 1:52 BEACH RD
Mailing Address - Street 2:STE 104
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6017
Mailing Address - Country:US
Mailing Address - Phone:203-254-2000
Mailing Address - Fax:203-255-3126
Practice Address - Street 1:1233 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-5381
Practice Address - Country:US
Practice Address - Phone:413-539-2845
Practice Address - Fax:413-539-2992
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001639363A00000X
MAPA5787363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001639OtherPA LICENSE
CT003016391Medicaid