Healthcare Provider Details

I. General information

NPI: 1275982746
Provider Name (Legal Business Name): SAMANTHA N BARRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9403 KENWOOD RD STE B100
BLUE ASH OH
45242-6858
US

IV. Provider business mailing address

5298 SOCIALVILLE FOSTER RD
MASON OH
45040-9302
US

V. Phone/Fax

Practice location:
  • Phone: 513-770-4212
  • Fax: 513-770-4213
Mailing address:
  • Phone: 513-770-4212
  • Fax: 513-770-4213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35.140391
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: