Provider Demographics
NPI:1740257427
Name:BARRY, ELLY (MD)
Entity type:Individual
Prefix:
First Name:ELLY
Middle Name:
Last Name:BARRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELOISA
Other - Middle Name:
Other - Last Name:FALZARANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:44 BINNEY ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6013
Mailing Address - Country:US
Mailing Address - Phone:617-632-6803
Mailing Address - Fax:
Practice Address - Street 1:44 BINNEY ST
Practice Address - Street 2:3RD FLOOR DANA FARBER CANCER INSTITUTE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-632-6803
Practice Address - Fax:617-632-3977
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216426208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
216426OtherTUFTS
MA2000016Medicaid
MAJ25822OtherBLUE CROSS BLUE SHIELD
A35465Medicare ID - Type Unspecified
MA2000016Medicaid