Healthcare Provider Details

I. General information

NPI: 1659802304
Provider Name (Legal Business Name): MARK EDWARD BARRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 BROADWAY
OAKLAND CA
94611-5730
US

IV. Provider business mailing address

3600 BROADWAY 3RD FLOOR, STATION 38
OAKLAND CA
94611-5730
US

V. Phone/Fax

Practice location:
  • Phone: 510-752-7499
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number61555976
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA160801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: