Provider Demographics
NPI:1568426880
Name:STAMM, BARRY D (MD)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:D
Last Name:STAMM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 STATE ST
Mailing Address - Street 2:STE 200
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1429
Mailing Address - Country:US
Mailing Address - Phone:814-453-4575
Mailing Address - Fax:814-459-3885
Practice Address - Street 1:300 STATE ST
Practice Address - Street 2:STE 200
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1429
Practice Address - Country:US
Practice Address - Phone:814-453-4575
Practice Address - Fax:814-459-3885
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020612E207W00000X
OH35038231S207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P009602OtherCHAMPUS
4102457OtherAETNA PPO
00020325001OtherUNIVERA
PA0005921260003Medicaid
4333210OtherCIGNA
68971OtherUNISON ADVANTAGE
0553817OtherAETNA HMO
00020325001OtherUNIVERA
4102457OtherAETNA PPO