Provider Demographics
NPI:1962030866
Name:BARR, MITSY MORENO (MD)
Entity Type:Individual
Prefix:
First Name:MITSY
Middle Name:MORENO
Last Name:BARR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MITSY
Other - Middle Name:JANET
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:809 82ND PKWY
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4607
Mailing Address - Country:US
Mailing Address - Phone:843-692-1118
Mailing Address - Fax:843-692-1122
Practice Address - Street 1:809 82ND PKWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4607
Practice Address - Country:US
Practice Address - Phone:843-692-1118
Practice Address - Fax:843-692-1122
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-28
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL84400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine