Provider Demographics
NPI:1730457417
Name:MAGEN, BARRY G (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:G
Last Name:MAGEN
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 1:840A S. AMERICAN ST.
Mailing Address - Street 2:
Mailing Address - City:PHILA.
Mailing Address - State:PA
Mailing Address - Zip Code:19147
Mailing Address - Country:US
Mailing Address - Phone:484-683-1746
Mailing Address - Fax:
Practice Address - Street 1:840A S AMERICAN ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19147-3331
Practice Address - Country:US
Practice Address - Phone:484-683-1746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD059830L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD059830LOtherPA LICENSE NUMBER