Provider Demographics
NPI:1134217441
Name:BARTTER, THADDEUS C (MD)
Entity type:Individual
Prefix:
First Name:THADDEUS
Middle Name:C
Last Name:BARTTER
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 1:4301 W MARKHAM ST # 555
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-686-8000
Mailing Address - Fax:
Practice Address - Street 1:4301 W MARKHAM ST # 555
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-686-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA52357207RC0200X, 207RP1001X
PAMD044300E207RC0200X
PAMD0443000E207RP1001X
ARE-5847207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P440699OtherOXFORD HEALTH PLAN
0255871000OtherAMERIHEALTH ,HMO KEYSTONE, IBC
3K6149OtherHEALTHNET
84039OtherAMERIGROUP
123444OtherAETNA
1037896OtherHORIZON NJ HEALTH
1242870OtherUNITED HEALTH CARE
3903171OtherCIGNA
NJ3992101Medicaid
CA0000028 02OtherAMERICHOICE
110084234OtherRAIL RAOD MEDICARE
196463OtherAMERIHEALTH PPO
42403OtherUNIVERSITY HEALTH PLAN
AR5H404Medicare PIN
0255871000OtherAMERIHEALTH ,HMO KEYSTONE, IBC
3K6149OtherHEALTHNET