Healthcare Provider Details

I. General information

NPI: 1336170984
Provider Name (Legal Business Name): NANCY-NICHOLE BARRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: N. NICHOLE BARRY MD

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 NORTHPORT AVE STE 220
BELFAST ME
04915-6096
US

IV. Provider business mailing address

116 NORTHPORT AVE STE 220
BELFAST ME
04915-6096
US

V. Phone/Fax

Practice location:
  • Phone: 207-505-4015
  • Fax: 207-338-8368
Mailing address:
  • Phone: 207-505-4015
  • Fax: 207-338-8368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberG79187
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD28601
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: