Individual
DR. BARRY J LIFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-5122
(843) 792-1414
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
21082
WV
208800000X
Urology Physician
Primary
83343
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000272087
BLUE CROSS BLUE SHIELD
WV
01
—
005185537
AETNA
WV
05
—
2393806
—
OH
05
—
3003509000
—
WV
01
—
340020612
RAILROAD MEDICARE
WV
Enumeration date
06/04/2006
Last updated
10/26/2020
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