Provider Demographics
NPI:1871857300
Name:DEESE, BARRY L (AUD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:L
Last Name:DEESE
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 5TH AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-217-4217
Practice Address - Street 1:755 NORLAND AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201
Practice Address - Country:US
Practice Address - Phone:717-217-6870
Practice Address - Fax:717-217-6945
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006258231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50110068OtherCAPITAL BLUE CROSS
PA002711533OtherHIGHMARK BLUE SHIELD
PAP01100007OtherRAILROAD MEDICARE
PAP01100007OtherRAILROAD MEDICARE