Provider Demographics
NPI:1902445273
Name:BARTLETT, LARRY D JR (PEER SPECALIST)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:D
Last Name:BARTLETT
Suffix:JR
Gender:M
Credentials:PEER SPECALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1149 SULLIVAN ST STE B
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-1670
Mailing Address - Country:US
Mailing Address - Phone:607-733-7661
Mailing Address - Fax:607-733-7675
Practice Address - Street 1:1149 SULLIVAN ST STE B
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-1670
Practice Address - Country:US
Practice Address - Phone:607-733-7661
Practice Address - Fax:607-733-7675
Is Sole Proprietor?:No
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist