Provider Demographics
NPI:1790753887
Name:BARRY, THOMAS BERNARD (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:BERNARD
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 1:345 E 61ST ST
Mailing Address - Street 2:1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8216
Mailing Address - Country:US
Mailing Address - Phone:860-294-1283
Mailing Address - Fax:
Practice Address - Street 1:345 E 61ST ST
Practice Address - Street 2:1-C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8216
Practice Address - Country:US
Practice Address - Phone:860-294-1283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD422021207P00000X
NY162826207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1531382OtherHIGHMARK BS
PA0019680380001Medicaid
PA2216925000OtherINDEPENDENCE BC
PA1531382OtherHIGHMARK BS
PA0019680380001Medicaid