Provider Demographics
NPI:1255334611
Name:BARRY, JAMES H (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:H
Last Name:BARRY
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 1:2912 SPRINGBORO W
Mailing Address - Street 2:STE 201
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1674
Mailing Address - Country:US
Mailing Address - Phone:937-297-8996
Mailing Address - Fax:937-396-0045
Practice Address - Street 1:78 REMICK BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-9168
Practice Address - Country:US
Practice Address - Phone:937-886-9017
Practice Address - Fax:937-886-9055
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35040502B207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH080191711OtherRAILROAD MEDICARE
OH000000227889OtherANTHEM
OH45658-0001OtherCARESOURCE
OH633746OtherAETNA
OH0364510Medicaid
OH40503-04OtherHUMANA/CHOICECARE
OHBA0435619Medicare PIN
OHA76234Medicare UPIN