Provider Demographics
NPI:1336188127
Name:BARR, MATTHEW DONALD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:DONALD
Last Name:BARR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 BEACH RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6017
Mailing Address - Country:US
Mailing Address - Phone:203-255-2003
Mailing Address - Fax:203-319-7583
Practice Address - Street 1:52 BEACH RD
Practice Address - Street 2:SUITE 207
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6017
Practice Address - Country:US
Practice Address - Phone:203-255-2003
Practice Address - Fax:203-319-7583
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT000905363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT290000905CT01OtherANTHEM BLUE CROSS
CT2V4013OtherHEALTH NET
CT2V4013OtherHEALTH NET