Provider Demographics
NPI:1710985171
Name:BATES, BARRY (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:BATES
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 710964
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-0964
Mailing Address - Country:US
Mailing Address - Phone:866-287-3268
Mailing Address - Fax:
Practice Address - Street 1:1275 N HIGH ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-8273
Practice Address - Country:US
Practice Address - Phone:937-393-6126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350648002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00000007798OtherBC/BS INDIVIDUAL PIN NO
OH0933511Medicaid
OH00000007798OtherBC/BS INDIVIDUAL PIN NO
B48687Medicare UPIN