Provider Demographics
NPI:1265614473
Name:ANTHONY R BARRI MD PC
Entity type:Organization
Organization Name:ANTHONY R BARRI MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:BARRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-445-2461
Mailing Address - Street 1:489 GOLD STAR HIGHWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340
Mailing Address - Country:US
Mailing Address - Phone:860-445-2461
Mailing Address - Fax:860-445-8512
Practice Address - Street 1:489 GOLD STAR HIGHWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340
Practice Address - Country:US
Practice Address - Phone:860-445-2461
Practice Address - Fax:860-445-8512
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANTHONY R BARRI MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-29
Last Update Date:2008-09-03
Deactivation Date:2008-06-03
Deactivation Code:
Reactivation Date:2008-09-03
Provider Licenses
StateLicense IDTaxonomies
CT00411156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004115681Medicaid
CT004115681Medicaid
CT0143100001Medicare NSC