Basic Information
| Provider Information | |||||||||
| NPI: | 1558399766 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARRY | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 457 TIMOTHY DR | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180172460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108656974 | ||||||||
| FaxNumber: | 6108684764 | ||||||||
| Practice Location | |||||||||
| Address1: | 268 HIGHLAND PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | WILKES BARRE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 187026768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5708228831 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 11/15/2011 | ||||||||
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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 | OS-006763-L | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208D00000X | OS006763-L | PA | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.