MEDICARE: BARRY SCOTT STEVENS MD

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
1	2085R0202X	Diagnostic Radiology Physician	35084654	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00198118	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000339181	OTHER	OH	BC BS

General Provider Information

NPI Number	:	1174521546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARRY SCOTT STEVENS MD

Provider Business Mailing Address
First Line	:	PO BOX 711919
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45271-0001
Country	:	US
Telephone Number	:	866-286-5884
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 N WILSON DR
Second Line	:
City	:	WEST UNION
State	:	OH
Zip	:	45693-1577
Country	:	US
Telephone Number	:	937-544-1544
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	07/18/2007

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