1114113545 NPI number — FREDERICK A BARKS, JR

Table of content: JON CURTIS MARTIN D.O. (NPI 1184157810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114113545 NPI number — FREDERICK A BARKS, JR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FREDERICK A BARKS, JR
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1114113545
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
245 SCHOOL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUTNAM
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06260-1621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-928-7729
Provider Business Mailing Address Fax Number:
860-928-0593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
245 SCHOOL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PUTNAM
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06260-1621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-928-7729
Provider Business Practice Location Address Fax Number:
860-928-0593
Provider Enumeration Date:
09/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BARKS
Authorized Official First Name:
FREDERICK
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
860-928-7729

Provider Taxonomy Codes

  • Taxonomy code: 111NN1001X , with the licence number:  001391 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3823400 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: C03295 . This is a "MEDICARE GROUP ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 050001391CT02 . This is a "BCBS OF CT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2V5130 . This is a "HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 412398 . This is a "BLUE CHIP OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 010391 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: AA32943 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P00217640 . This is a "MEDICARE ID - RAILROAD ME" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 1030756 . This is a "ASHN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: P2686322 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 29336-1 . This is a "BCBS OF RI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 4404611 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 06985925002 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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