Provider Demographics
NPI:1558307330
Name:BARTH, KONRAD NM (MD)
Entity Type:Individual
Prefix:
First Name:KONRAD
Middle Name:NM
Last Name:BARTH
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 1:301C US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9701
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:49 SPRING ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8926
Practice Address - Country:US
Practice Address - Phone:207-885-4479
Practice Address - Fax:207-883-2586
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEMD13788207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30006922Medicaid
ME240970099Medicaid
NH30006922Medicaid
MEMM542201Medicare PIN
MEP00441384Medicare PIN
MEMM542202Medicare PIN
MEF81331Medicare UPIN
MEMM5422Medicare PIN