Provider Demographics
NPI:1174534036
Name:REBECK, BARRY MARTIN (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:MARTIN
Last Name:REBECK
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 1:1010 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:MC KEE
Mailing Address - State:KY
Mailing Address - Zip Code:40447-7089
Mailing Address - Country:US
Mailing Address - Phone:859-626-7700
Mailing Address - Fax:859-626-7890
Practice Address - Street 1:401 HIGHLAND PARK DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3839
Practice Address - Country:US
Practice Address - Phone:859-626-7700
Practice Address - Fax:859-626-7890
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY323602084P0800X
NHLT35482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY32360OtherMEDICAL LICENSE - KENTUCKY
NC9900330OtherMEDICAL LICENSE - NORTH CAROLINA
KY7100142440Medicaid
KY32360OtherMEDICAL LICENSE - KENTUCKY
KY0046712Medicare PIN