=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841268653
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOHAMMAD M BARI PHYSICIAN PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2006
-----------------------------------------------------
Last Update Date | 12/26/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 560 W 3RD ST
-----------------------------------------------------
City | JAMESTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-483-2603
-----------------------------------------------------
Fax | 716-483-2828
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 560 W 3RD ST
-----------------------------------------------------
City | JAMESTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-483-2603
-----------------------------------------------------
Fax | 716-483-2828
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MOHAMMAD M BARI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 71648336033
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0200X
-----------------------------------------------------
Taxonomy Name | Infectious Disease Physician
-----------------------------------------------------
License Number | 199853
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------