Healthcare Provider Details

I. General information

NPI: 1497712277
Provider Name (Legal Business Name): BARRY ANTHONY SCANLAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W TRADE ST STE A
DALLAS NC
28034-1543
US

IV. Provider business mailing address

PO BOX 744786
ATLANTA GA
30374-4786
US

V. Phone/Fax

Practice location:
  • Phone: 980-834-9130
  • Fax: 980-834-9869
Mailing address:
  • Phone: 704-834-2450
  • Fax: 704-671-5331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9401016
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: