Healthcare Provider Details

I. General information

NPI: 1720142714
Provider Name (Legal Business Name): MICHELLE BARR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 CITY HALL MALL
MEDFORD MA
02155
US

IV. Provider business mailing address

26 CITY HALL MALL
MEDFORD MA
02155
US

V. Phone/Fax

Practice location:
  • Phone: 781-306-5100
  • Fax:
Mailing address:
  • Phone: 781-306-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number206499
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: