Provider Demographics
NPI:1801090642
Name:BARI, MOHAMMAD M (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:M
Last Name:BARI
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 1:250 FAME AVE STE 206A
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-1587
Mailing Address - Country:US
Mailing Address - Phone:717-316-2248
Mailing Address - Fax:
Practice Address - Street 1:250 FAME AVE STE 206A
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1587
Practice Address - Country:US
Practice Address - Phone:717-316-2248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058885L207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
56787BMedicare PIN
PA169104ZEA5Medicare PIN
G53928Medicare UPIN
RB4948Medicare PIN
FIDELISOther040426003875
G53928Medicare UPIN
NY01775442Medicaid
79916OtherGHI HMO
000524805004OtherBCBS
PA102400111Medicaid
0409460OtherINDEPENDENT HEALTH
8084144OtherPHCS CIGNA
RB4948Medicare PIN