Healthcare Provider Details

I. General information

NPI: 1609878545
Provider Name (Legal Business Name): ARCHANA BARRY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date: 03/22/2006
Reactivation Date: 04/06/2006

III. Provider practice location address

720 N MARR RD
COLUMBUS IN
47201
US

IV. Provider business mailing address

645 S ROGERS ST
BLOOMINGTON IN
47403-2353
US

V. Phone/Fax

Practice location:
  • Phone: 812-314-3500
  • Fax:
Mailing address:
  • Phone: 812-339-1691
  • Fax: 812-337-2438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01037278A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: