Provider Demographics
NPI:1932274933
Name:MARMORSTEIN, BARRY L (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:L
Last Name:MARMORSTEIN
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:PO BOX 1444
Mailing Address - Street 2:
Mailing Address - City:ABIQUIU
Mailing Address - State:NM
Mailing Address - Zip Code:87510-1444
Mailing Address - Country:US
Mailing Address - Phone:505-685-4325
Mailing Address - Fax:
Practice Address - Street 1:1023 COUNTY ROAD 142
Practice Address - Street 2:
Practice Address - City:ABIQUIU
Practice Address - State:NM
Practice Address - Zip Code:87510-1444
Practice Address - Country:US
Practice Address - Phone:505-685-4325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00013991207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1540707Medicaid
WA290001897OtherRAILROAD MEDICARE
WA0014435OtherDEPT OF LABOR & INDUSTRY
WA5558MAOtherREGENCE SPECIALIST
WAM123OtherREGENCE PRIMARY CARE
WA3362773000OtherOWCP
WA8921640OtherL&I CRIME VICTIMS
WA5558MAOtherREGENCE SPECIALIST
WA8921640OtherL&I CRIME VICTIMS