Basic Information
Provider Information | |||||||||
NPI: | 1407946460 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BARR | ||||||||
FirstName: | PAUL | ||||||||
MiddleName: | MICHAEL | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 601 ELMWOOD AVE | ||||||||
Address2: | BOX MED | ||||||||
City: | ROCHESTER | ||||||||
State: | NY | ||||||||
PostalCode: | 146420001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5852755823 | ||||||||
FaxNumber: | 5852731051 | ||||||||
Practice Location | |||||||||
Address1: | 601 ELMWOOD AVE | ||||||||
Address2: | BOX MED | ||||||||
City: | ROCHESTER | ||||||||
State: | NY | ||||||||
PostalCode: | 146420001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5852755823 | ||||||||
FaxNumber: | 5852731051 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/13/2006 | ||||||||
LastUpdateDate: | 07/20/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35082046 | OH | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RH0000X | 257275-1 | NY | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | 207RX0202X | 257275-1 | NY | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
ID | Type | State | Issuer | Description | 414943 | 01 | OH | WELLCARE # | OTHER | 000000524528 | 01 | OH | ANTHEM # | OTHER | 750463 | 01 | OH | BUCKEYE # | OTHER | P00431954 | 01 | OH | MEDICARE RAILROAD | OTHER | 000000221149 | 01 | OH | UNISON # | OTHER | 2762578 | 05 | OH |   | MEDICAID | 9456056 | 01 | OH | AETNA # | OTHER |