Basic Information
| Provider Information | |||||||||
| NPI: | 1790760932 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARRON | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 COMMERCE WAY | ||||||||
| Address2: | STE 120 | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038018200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034278066 | ||||||||
| FaxNumber: | 6035010495 | ||||||||
| Practice Location | |||||||||
| Address1: | 96 CALEF HWY | ||||||||
| Address2: | SUITE 8 | ||||||||
| City: | EPPING | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030422224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6036793700 | ||||||||
| FaxNumber: | 6036793733 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2005 | ||||||||
| LastUpdateDate: | 10/13/2016 | ||||||||
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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 | 225100000X | 16411 | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 7725696 | 01 | MA | AETNA | OTHER | AA45429 | 01 | MA | HARVARD PILGRIM HEALTH CA | OTHER | 0000Y68413 | 01 | MA | BLUE CROSS BLUE SHIELD | OTHER | 8077207 | 01 | MA | CIGNA | OTHER | 470390 | 01 | MA | TUFTS | OTHER |