Basic Information
Provider Information
NPI: 1427585629
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARASCH
FirstName: AARON
MiddleName: CHARLES
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7 DOCK HILL RD
Address2:  
City: MIDDLEBURG
State: PA
PostalCode: 178428910
CountryCode: US
TelephoneNumber: 5708372123
FaxNumber: 5708372185
Practice Location
Address1: 4830 LONDONDERRY RD
Address2:  
City: HARRISBURG
State: PA
PostalCode: 171095207
CountryCode: US
TelephoneNumber: 7176572595
FaxNumber: 7176573091
Other Information
ProviderEnumerationDate: 05/18/2017
LastUpdateDate: 12/30/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/30/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XOS019574PAY193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
1D431901PAMEDICAREOTHER
103359717000805PA MEDICAID


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