Provider Demographics
NPI:1801882881
Name:BARINAGA, MARY ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:BARINAGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21651 S LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WORLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83876-7615
Mailing Address - Country:US
Mailing Address - Phone:208-667-1204
Mailing Address - Fax:
Practice Address - Street 1:1115 B STREET
Practice Address - Street 2:
Practice Address - City:PLUMMER
Practice Address - State:ID
Practice Address - Zip Code:83851
Practice Address - Country:US
Practice Address - Phone:208-686-1931
Practice Address - Fax:208-686-0242
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM7054207Q00000X
WAMD00036315207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID003583200Medicaid
ID003583200Medicaid
ID11350212Medicare PIN
1135021Medicare ID - Type Unspecified