Provider Demographics
NPI:1710934047
Name:EHRLICH, BARRY A (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:A
Last Name:EHRLICH
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 1:75 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-2602
Mailing Address - Country:US
Mailing Address - Phone:617-243-5590
Mailing Address - Fax:617-243-5981
Practice Address - Street 1:9 HOPE AVENUE
Practice Address - Street 2:WALTHAM URGENT CARE CENTER
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453
Practice Address - Country:US
Practice Address - Phone:617-243-5590
Practice Address - Fax:617-243-5981
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA71676207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3058417Medicaid
MA3058417Medicaid