Provider Demographics
NPI:1871883371
Name:BARRETT, MARY MARTHA (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:MARTHA
Last Name:BARRETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 MURRAY RD
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-9144
Mailing Address - Country:US
Mailing Address - Phone:518-860-9913
Mailing Address - Fax:
Practice Address - Street 1:1650 MURRAY RD
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-9144
Practice Address - Country:US
Practice Address - Phone:518-860-9913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213246207R00000X
NY279926207ZP0102X, 207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology