Provider Demographics
NPI:1770818205
Name:BARRY, AARON (MD)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:BARRY
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 1:482 40TH ST
Mailing Address - Street 2:APT 15
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-2568
Mailing Address - Country:US
Mailing Address - Phone:734-330-9102
Mailing Address - Fax:
Practice Address - Street 1:482 40TH ST
Practice Address - Street 2:APT 15
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2568
Practice Address - Country:US
Practice Address - Phone:734-330-9102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA115405207L00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program