Provider Demographics
NPI:1255381026
Name:BARRY, DANIEL J (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
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 1:4901 COTTAGE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53716-1392
Mailing Address - Country:US
Mailing Address - Phone:608-221-1501
Mailing Address - Fax:608-223-3540
Practice Address - Street 1:4901 COTTAGE GROVE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53716-1392
Practice Address - Country:US
Practice Address - Phone:608-221-1501
Practice Address - Fax:608-223-3540
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18809207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30103200Medicaid
WI000215115Medicare ID - Type Unspecified
WI30103200Medicaid