Provider Demographics
NPI:1700961513
Name:BARKEN, FREDERICK MITCHELL (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:MITCHELL
Last Name:BARKEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2333 N TRIPHAMMER RD
Mailing Address - Street 2:STE 302
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1075
Mailing Address - Country:US
Mailing Address - Phone:607-257-1126
Mailing Address - Fax:607-257-0955
Practice Address - Street 1:2333 N TRIPHAMMER RD
Practice Address - Street 2:STE 302
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1075
Practice Address - Country:US
Practice Address - Phone:607-257-1126
Practice Address - Fax:607-257-0955
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157087207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00829070Medicaid
00091661001OtherHEALTH NOW
4305837OtherAETNA
NY00829070Medicaid
B82444Medicare UPIN