Provider Demographics
NPI:1639171176
Name:BARK, JOSEPH PAUL (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:PAUL
Last Name:BARK
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 1:1401 HARRODSBURG ROAD
Mailing Address - Street 2:C415
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504
Mailing Address - Country:US
Mailing Address - Phone:859-278-9492
Mailing Address - Fax:859-277-3027
Practice Address - Street 1:1401 HARRODSBURG ROAD
Practice Address - Street 2:C415
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504
Practice Address - Country:US
Practice Address - Phone:859-278-9492
Practice Address - Fax:859-277-3027
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY16820174400000X
KY16820207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY070003748OtherRAILROAD MEDICARE
KY64168206002Medicaid
KY65926933Medicaid
KY070003748OtherRAILROAD MEDICARE
KY1047601Medicare PIN
KYC69635Medicare UPIN