Provider Demographics
NPI:1588680524
Name:BARR, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:BARR
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:PO BOX 1188
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29551-1188
Mailing Address - Country:US
Mailing Address - Phone:843-917-4958
Mailing Address - Fax:843-917-4964
Practice Address - Street 1:701 MEDICAL PARK DR
Practice Address - Street 2:SUITE 205
Practice Address - City:HARTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29550-4777
Practice Address - Country:US
Practice Address - Phone:843-917-4958
Practice Address - Fax:843-917-4964
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116686208800000X
SC31325208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00351446Medicaid
NY644431Medicare ID - Type Unspecified
NY00351446Medicaid