Provider Demographics
NPI:1295708576
Name:BARGER, ANDREW V (MD, PHD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:V
Last Name:BARGER
Suffix:
Gender:M
Credentials:MD, PHD
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 742816
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-2816
Mailing Address - Country:US
Mailing Address - Phone:530-332-6300
Mailing Address - Fax:530-893-6936
Practice Address - Street 1:1600 ESPLANADE STE C
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3369
Practice Address - Country:US
Practice Address - Phone:530-332-4470
Practice Address - Fax:530-893-6885
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN459242085R0202X
IN01068471A2085R0202X
HI146532085R0202X
CAA985602085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200994380Medicaid
OH3078691Medicaid
MI1295708576Medicaid
OH3078691Medicaid
MI1295708576Medicaid
MIP00950291Medicare PIN
INM400025354Medicare PIN
H92600Medicare UPIN
MIMI1209039Medicare PIN