Provider Demographics
NPI:1902161896
Name:BARRY-HUNDEYIN, MAUTIN TEMITOPE (MD)
Entity Type:Individual
Prefix:DR
First Name:MAUTIN
Middle Name:TEMITOPE
Last Name:BARRY-HUNDEYIN
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 1:800 ROSE ST FL 1
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-7001
Mailing Address - Country:US
Mailing Address - Phone:859-259-4488
Mailing Address - Fax:
Practice Address - Street 1:800 ROSE ST FL 1
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-5501
Practice Address - Country:US
Practice Address - Phone:859-323-6542
Practice Address - Fax:859-323-2074
Is Sole Proprietor?:No
Enumeration Date:2012-07-07
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA252752390200000X
KYTP9502086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program