Provider Demographics
NPI:1558441949
Name:GENDRON, BARRY CHARLES (DO)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:CHARLES
Last Name:GENDRON
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 1:240 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOLFEBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03894-4455
Mailing Address - Country:US
Mailing Address - Phone:603-569-7690
Mailing Address - Fax:603-569-7664
Practice Address - Street 1:875 GREENLAND RD
Practice Address - Street 2:SUITE C4
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4164
Practice Address - Country:US
Practice Address - Phone:603-431-5529
Practice Address - Fax:603-436-6603
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH89322081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3074946Medicaid
NHRE2688Medicare ID - Type Unspecified