Healthcare Provider Details

I. General information

NPI: 1134121171
Provider Name (Legal Business Name): ERIC W BARRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MEDICAL CENTER PKWY
AUGUSTA ME
04330-8160
US

IV. Provider business mailing address

35 MEDICAL CENTER PKWY
AUGUSTA ME
04330-8160
US

V. Phone/Fax

Practice location:
  • Phone: 207-622-1959
  • Fax: 207-430-6400
Mailing address:
  • Phone: 207-622-1959
  • Fax: 207-430-4007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number015523
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number015523
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: