Provider Demographics
NPI:1750450524
Name:SACKS, BARRY AUBREY (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:AUBREY
Last Name:SACKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MRS
Other - First Name:YVONNE
Other - Middle Name:STEPHANIE
Other - Last Name:SACKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:84 VINE ST
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3050
Mailing Address - Country:US
Mailing Address - Phone:617-965-2508
Mailing Address - Fax:617-965-3320
Practice Address - Street 1:67 UNION ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-7700
Practice Address - Country:US
Practice Address - Phone:508-650-7333
Practice Address - Fax:508-650-7370
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA385232085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Not Answered2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2055449Medicaid
MAB76428Medicare UPIN
MA2055449Medicaid