Provider Demographics
NPI:1770665523
Name:SMITH, BARRY L (DO)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:L
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
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 410
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01021-0410
Mailing Address - Country:US
Mailing Address - Phone:866-662-1606
Mailing Address - Fax:413-789-8041
Practice Address - Street 1:271 CAREW ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-2377
Practice Address - Country:US
Practice Address - Phone:413-748-9321
Practice Address - Fax:413-452-6080
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54469207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3001652Medicaid
NY02532694Medicaid
MAJ07905Medicare PIN
D87823Medicare UPIN
MA3001652Medicaid