Provider Demographics
NPI:1568456457
Name:BICKLEY, BARRY THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:THOMAS
Last Name:BICKLEY
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 1:288 GROVELAND ST
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6674
Mailing Address - Country:US
Mailing Address - Phone:978-373-3851
Mailing Address - Fax:978-521-6542
Practice Address - Street 1:288 GROVELAND ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6674
Practice Address - Country:US
Practice Address - Phone:978-373-3851
Practice Address - Fax:978-521-6542
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159044174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3194361Medicaid
MAG90753Medicare UPIN
MAA29419Medicare ID - Type Unspecified