Provider Demographics
NPI:1023095924
Name:DIDUCH, BARRY KENT (MD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:KENT
Last Name:DIDUCH
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:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:540-932-5162
Mailing Address - Fax:540-932-5875
Practice Address - Street 1:851 STATLER BLVD
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401
Practice Address - Country:US
Practice Address - Phone:540-245-7470
Practice Address - Fax:540-245-7766
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-052714207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005625246Medicaid
VA005625246Medicaid
080005843Medicare ID - Type Unspecified