Provider Demographics
NPI:1730115148
Name:ENGELSTAD, BARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:
Last Name:ENGELSTAD
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 1:2125 OAK GROVE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2536
Mailing Address - Country:US
Mailing Address - Phone:925-296-7150
Mailing Address - Fax:925-296-7171
Practice Address - Street 1:2125 OAK GROVE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2536
Practice Address - Country:US
Practice Address - Phone:925-296-7150
Practice Address - Fax:925-296-7171
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG413592085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G4135918Medicare PIN
CA00G413594Medicare PIN
CA300093154Medicare PIN
CA00G4135910Medicare PIN
CA00G4135915Medicare PIN
CA00G413595Medicare PIN
CA00G413599Medicare PIN
CA300039791Medicare PIN
CA00G413590Medicare PIN
CA00G4135917Medicare PIN
CA00G4135921Medicare PIN
CAA48545Medicare UPIN
CA00G4135912Medicare PIN
CA00G413593Medicare PIN
CA00G413591Medicare PIN
CA00G4135911Medicare PIN
CA00G4135916Medicare PIN
CA00G413592Medicare PIN
CA300082382Medicare PIN
CA300104829Medicare PIN
CA00G4135919Medicare PIN
CA00G413598Medicare PIN
CA00G4135920Medicare PIN