Provider Demographics
NPI:1831373562
Name:BARTHA, AGNES IDA (MD)
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:IDA
Last Name:BARTHA
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 1:7010 E CHAUNCEY LN
Mailing Address - Street 2:SUITE 225
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-3111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7010 E CHAUNCEY LN
Practice Address - Street 2:SUITE 225
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-3111
Practice Address - Country:US
Practice Address - Phone:480-585-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ434732080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine