1235154741 NPI number — DR. BARRY L BAKST D.O.

Table of content: DR. BARRY L BAKST D.O. (NPI 1235154741)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235154741 NPI number — DR. BARRY L BAKST D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAKST
Provider First Name:
BARRY
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235154741
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2006 FOULK RD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19810-3644
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-529-8783
Provider Business Mailing Address Fax Number:
302-529-7470

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2006 FOULK RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19810-3644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-529-8783
Provider Business Practice Location Address Fax Number:
302-529-7470
Provider Enumeration Date:
07/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2081S0010X , with the licence number:  C20002764 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2445310 . This is a "CIGNA" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 510329923 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 510329923 . This is a "TRICARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: P3278310 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 0000102003 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2008059 . This is a "AETNA-HMO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 4295831 . This is a "AETNA-PPO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 510329923 . This is a "DEVON NETWORK" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 293733 . This is a "MAMSI" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 0000102003 . This is a "DE PHYSICIANS CARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 250008397 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 44003 . This is a "COVENTRY" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0091456000 . This is a "AMERIHEALTH-HMO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 193245 . This is a "AMERIHEALTH-PPO" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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