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NPI Code Detail

MEDICARE: MARY G. BARRY M.D.

MEDICARE: MARY G. BARRY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician25092KY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2110139124OTHERKYRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100000050959OTHERKYANTHEM / NCMA
31054765OTHERKYPASSPORT / NCMA
4000026447DOTHERKYHUMANA / NCMA
5008914OTHERKYSIHO / NCMA
62433720000OTHERKYPASSPORT ADVANTAGE / NCMA
7MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154386670
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY G. BARRY M.D.
Provider Business Mailing Address
First Line : PO BOX 776351
Second Line :
City : CHICAGO
State : IL
Zip : 60677-6351
Country : US
Telephone Number : 502-272-5100
Fax Number : 502-272-5116
Provider Business Practice Location Address
First Line : 825 BARRET AVE
Second Line :
City : LOUISVILLE
State : KY
Zip : 40204-1743
Country : US
Telephone Number : 502-540-7200
Fax Number : 502-540-7207
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2006
Last Update Date : 09/28/2020

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