1700863628 NPI number — DR. MICHAEL BARAM MD

Table of content: DR. MICHAEL BARAM MD (NPI 1700863628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700863628 NPI number — DR. MICHAEL BARAM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARAM
Provider First Name:
MICHAEL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1700863628
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
834 WALNUT ST
Provider Second Line Business Mailing Address:
SUITE 650
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19107-5109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
834 WALNUT STREET SUITE 650
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19107-5595
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-955-6591
Provider Business Practice Location Address Fax Number:
215-955-0830
Provider Enumeration Date:
12/30/2005

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: 207RP1001X , with the licence number:  MD429703 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 64732201 . This is a "CARE FIRST BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0001123901 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5865228 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1000038354 . This is a "DELAWARE PHYSICIANS CARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 1121763 . This is a "AETNA/USHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2623620000 . This is a "INDEPENDENCE BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 414303 . This is a "COVENTRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0112542 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101767112 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2623620000 . This is a "AMERIHEALTH/KEYSTONE" identifier . This identifiers is of the category "OTHER".




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