Basic Information
| Provider Information | |||||||||
| NPI: | 1427050939 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARR | ||||||||
| FirstName: | WENDY | ||||||||
| MiddleName: | BROOKS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34 HAVERHILL ST | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018412884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786860090 | ||||||||
| FaxNumber: | 9786815963 | ||||||||
| Practice Location | |||||||||
| Address1: | 34 HAVERHILL ST | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018412884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9786860090 | ||||||||
| FaxNumber: | 9786815963 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2005 | ||||||||
| LastUpdateDate: | 03/07/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | 233892 | NY | N | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | 207Q00000X | 244387 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00903700 | 05 | NY | MEDICAID |