Healthcare Provider Details

I. General information

NPI: 1295799500
Provider Name (Legal Business Name): BARRY HUGO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SHAPE DR
KENNEBUNK ME
04043-6601
US

IV. Provider business mailing address

14 PROSPECT ST
MILFORD MA
01757-3003
US

V. Phone/Fax

Practice location:
  • Phone: 207-467-8955
  • Fax: 207-467-8959
Mailing address:
  • Phone: 508-422-2631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number016241
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier048516
Identifier TypeOTHER
Identifier StateLA
Identifier IssuerANTHEM
# 2
Identifier273830099
Identifier TypeMEDICAID
Identifier StateME
Identifier Issuer
# 3
IdentifierAA21113
Identifier TypeOTHER
Identifier StateME
Identifier IssuerHARVARD PILGRIM
# 4
Identifier3615048
Identifier TypeOTHER
Identifier StateME
Identifier IssuerAETNA
# 5
Identifier8254567
Identifier TypeOTHER
Identifier StateME
Identifier IssuerCIGNA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: