Provider Demographics
NPI:1710263348
Name:BARR, ABBY L (PA-C)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:L
Last Name:BARR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 E WATERLOO RD
Mailing Address - Street 2:STE 313
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-3856
Mailing Address - Country:US
Mailing Address - Phone:330-208-2720
Mailing Address - Fax:
Practice Address - Street 1:2215 E WATERLOO RD
Practice Address - Street 2:STE 313
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-3856
Practice Address - Country:US
Practice Address - Phone:330-208-2720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-003391363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0070047Medicaid
OHH044951Medicare PIN