Provider Demographics
NPI:1053382671
Name:LANDAU, BARRY JAY (MD)
Entity type:Individual
Prefix:DR
First Name:BARRY
Middle Name:JAY
Last Name:LANDAU
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 1:710 BIRCHWOOD AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1720
Mailing Address - Country:US
Mailing Address - Phone:360-676-0922
Mailing Address - Fax:360-671-4726
Practice Address - Street 1:710 BIRCHWOOD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1720
Practice Address - Country:US
Practice Address - Phone:360-676-0922
Practice Address - Fax:360-671-4726
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039977207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8278863Medicaid
F48710Medicare UPIN
WAAB23015Medicare ID - Type Unspecified