Basic Information
| Provider Information | |||||||||
| NPI: | 1366426157 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARB | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1234 E DUPONT RD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468251545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2603739700 | ||||||||
| FaxNumber: | 2603739740 | ||||||||
| Practice Location | |||||||||
| Address1: | 11123 PARKVIEW PLAZA DR | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468451707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2606726550 | ||||||||
| FaxNumber: | 2606726559 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2005 | ||||||||
| LastUpdateDate: | 07/21/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 01058845A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 01058845A | IN | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 000000337241 | 01 | IN | ANTHEM | OTHER | 3937240021 | 01 | IN | MEDICARE DMEPOS | OTHER | 7482611 | 01 | AETNA | OTHER | 3937240024 | 01 | IN | MEDICARE DMFPOS | OTHER | 000000337237 | 01 | IN | ANTHEM | OTHER | P00160977 | 01 | RAILROAD MEDICARE | OTHER | 200491340 | 05 | IN | MEDICAID | 15677 | 01 | IN | PHYSICIANS HEALTH PLAN | OTHER |