Provider Demographics
NPI:1619977675
Name:KILBOURNE, BARRY JOSEPH (MD)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:JOSEPH
Last Name:KILBOURNE
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 1:309 COUNTY ROUTE 47
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-5405
Mailing Address - Country:US
Mailing Address - Phone:518-891-2688
Mailing Address - Fax:518-891-4120
Practice Address - Street 1:309 COUNTY ROUTE 47
Practice Address - Street 2:SUITE 1
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-5405
Practice Address - Country:US
Practice Address - Phone:518-891-2688
Practice Address - Fax:518-891-4120
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129150207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY50E101OtherBCBS
NY109016OtherMVP SELECT
NY1619977675OtherFIDELIS
NY50E101OtherBLUE CROSS BLUE SHIELD
NY000401212001OtherBLUE SHIELD OF NENY
NY00459467Medicaid
NYP00000040484OtherGHI FHP
NYDD2645OtherPALMETTO GBA
NYP00000040484OtherGHI FHP
NYDD2645OtherPALMETTO GBA