Basic Information
Provider Information | |||||||||
NPI: | 1235491440 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BARRON | ||||||||
FirstName: | DAVID | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D./PH.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 41201 SCHADDEN RD | ||||||||
Address2: |   | ||||||||
City: | ELYRIA | ||||||||
State: | OH | ||||||||
PostalCode: | 440352249 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4403240451 | ||||||||
FaxNumber: | 4403240441 | ||||||||
Practice Location | |||||||||
Address1: | 41201 SCHADDEN RD | ||||||||
Address2: |   | ||||||||
City: | ELYRIA | ||||||||
State: | OH | ||||||||
PostalCode: | 440352249 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4403240451 | ||||||||
FaxNumber: | 4403240441 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/13/2012 | ||||||||
LastUpdateDate: | 09/09/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/09/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 35.142640 | OH | Y |   | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | MD465818 | PA | N |   | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | BP10044138 | TX | N |   | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
ID | Type | State | Issuer | Description | 0456851 | 05 | OH |   | MEDICAID | 566843 | 01 | TX | TEXAS MEDICAL BOARD PHYSICIAN IN TRAINING PERMIT | OTHER |