Healthcare Provider Details

I. General information

NPI: 1497860290
Provider Name (Legal Business Name): BARRY M MAGNUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 03/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 GLOBAL WAY CONCENTRA
LINTHICUM MD
21090-0001
US

IV. Provider business mailing address

8522 WINDOW LATCH WAY
COLUMBIA MD
21045-5633
US

V. Phone/Fax

Practice location:
  • Phone: 410-487-8600
  • Fax:
Mailing address:
  • Phone: 410-487-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number71144
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0071608
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: