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NPI Code Detail

MEDICARE: MR. MATTHEW DONALD BARR PA-C

MEDICARE:  MR. MATTHEW DONALD BARR  PA-C
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
1363AS0400XSurgical Physician Assistant000905CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1290000905CT01OTHERCTANTHEM BLUE CROSS
22V4013OTHERCTHEALTH NET

General Provider Information

NPI Number : 1336188127
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MATTHEW DONALD BARR PA-C
Provider Business Mailing Address
First Line : 52 BEACH RD
Second Line : SUITE 207
City : FAIRFIELD
State : CT
Zip : 06824-6017
Country : US
Telephone Number : 203-255-2003
Fax Number : 203-319-7583
Provider Business Practice Location Address
First Line : 52 BEACH RD
Second Line : SUITE 207
City : FAIRFIELD
State : CT
Zip : 06824-6017
Country : US
Telephone Number : 203-255-2003
Fax Number : 203-319-7583
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2006
Last Update Date : 07/08/2007

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Directions to “ MR. MATTHEW DONALD BARR PA-C” Practice Location

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