Provider Demographics
NPI:1952590986
Name:BARRY, RAYMOND K (DC)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:K
Last Name:BARRY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8096 EDWIN RAYNOR BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-6837
Mailing Address - Country:US
Mailing Address - Phone:410-360-0014
Mailing Address - Fax:410-360-0064
Practice Address - Street 1:8096 EDWIN RAYNOR BLVD STE A
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-6837
Practice Address - Country:US
Practice Address - Phone:410-360-0014
Practice Address - Fax:410-360-0064
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01558111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKE24OtherBCBS OF MD
MD353259OtherMAMSI
MD2184080OtherAETNA
MD629389OtherACN
DC0001OtherBCBS OF DC
MD849QMedicare PIN
DC0001OtherBCBS OF DC
MD5556630001Medicare NSC