Provider Demographics
NPI:1912924879
Name:ZADEH, BARRY J (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:J
Last Name:ZADEH
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 1:48 EXECUTIVE DR
Mailing Address - Street 2:STE C
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-2492
Mailing Address - Country:US
Mailing Address - Phone:419-668-1155
Mailing Address - Fax:419-668-1145
Practice Address - Street 1:48 EXECUTIVE DR
Practice Address - Street 2:STE C
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2492
Practice Address - Country:US
Practice Address - Phone:419-668-1155
Practice Address - Fax:419-668-1145
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.088362208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001407456Medicaid
OH2692484Medicaid
OH2692484Medicaid
PA468505Medicare ID - Type Unspecified
PA001407456Medicaid