Provider Demographics
NPI:1023082229
Name:BLUMENTHAL, BARRY HOWARD (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:HOWARD
Last Name:BLUMENTHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 MEDICAL CENTER DR
Mailing Address - Street 2:CROSSROADS
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2332
Mailing Address - Country:US
Mailing Address - Phone:540-213-2525
Mailing Address - Fax:540-213-2502
Practice Address - Street 1:78 MEDICAL CENTER DR
Practice Address - Street 2:CROSSROADS
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2332
Practice Address - Country:US
Practice Address - Phone:540-213-2525
Practice Address - Fax:540-213-2502
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012312542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1042776OtherCIGNA BEHAVIORAL HEALTH
VA712159OtherFIRST HEALTH
VA174959OtherANTHEM
VA084148MOtherOPTIMA
VAC81530Medicare UPIN
VA174959OtherANTHEM
VAC03262Medicare PIN