Provider Demographics
NPI:1174521546
Name:STEVENS, BARRY SCOTT (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:SCOTT
Last Name:STEVENS
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:PO BOX 711919
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45271-0001
Mailing Address - Country:US
Mailing Address - Phone:866-286-5884
Mailing Address - Fax:
Practice Address - Street 1:210 N WILSON DR
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693-1577
Practice Address - Country:US
Practice Address - Phone:937-544-1544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350846542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2509717Medicaid
OHP00198118OtherRAILROAD MEDICARE
OH000000339181OtherBC BS
OHP00198118OtherRAILROAD MEDICARE
OH000000339181OtherBC BS