Provider Demographics
NPI:1558399766
Name:BARRY, THOMAS J JR (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:BARRY
Suffix:JR
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 1:457 TIMOTHY DR
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-2460
Mailing Address - Country:US
Mailing Address - Phone:610-865-6974
Mailing Address - Fax:610-868-4764
Practice Address - Street 1:268 HIGHLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6768
Practice Address - Country:US
Practice Address - Phone:570-822-8831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-006763-L207R00000X
PAOS006763-L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA125308Medicare PIN
PA615691YJSMedicare PIN
PA125184Medicare PIN
PA615691YJOMedicare UPIN
E55843Medicare UPIN