MEDICARE: CASEY LEE BARRY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	MD478934	PA

General Provider Information

NPI Number	:	1548766124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY LEE BARRY MD

Provider Business Mailing Address
First Line	:	100 E LANCASTER AVE
Second Line	:
City	:	WYNNEWOOD
State	:	PA
Zip	:	19096-3450
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 OFFICE CENTER DR STE 190-195
Second Line	:
City	:	FT WASHINGTON
State	:	PA
Zip	:	19034-3220
Country	:	US
Telephone Number	:	215-836-7900
Fax Number	:	215-836-7923

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2018
Last Update Date	:	08/02/2022

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