Provider Demographics
NPI:1891790259
Name:HASTINGS, BARRY RUSSELL (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:RUSSELL
Last Name:HASTINGS
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 1:1011 W H SMITH BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-3787
Mailing Address - Country:US
Mailing Address - Phone:252-754-8370
Mailing Address - Fax:252-754-8387
Practice Address - Street 1:1011 W H SMITH BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3787
Practice Address - Country:US
Practice Address - Phone:252-754-8370
Practice Address - Fax:252-754-8387
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800894208600000X
NC2000018300222086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891149VMedicaid
NCG75136Medicare UPIN
NC2251114Medicare PIN