1134275092 NPI number — DR. ROBERT K BARBOUR D.M.D.

Table of content: DR. ROBERT K BARBOUR D.M.D. (NPI 1134275092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134275092 NPI number — DR. ROBERT K BARBOUR D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARBOUR
Provider First Name:
ROBERT
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134275092
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1237 GEORGE WASHINGTON HWY N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESAPEAKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23323-5035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-487-3006
Provider Business Mailing Address Fax Number:
757-485-7307

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2520 GILMERTON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESAPEAKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23323-4906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-487-4121
Provider Business Practice Location Address Fax Number:
757-485-7307
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  0401006133 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: 5207 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6233 . This is a "DELTACARE PROV ID" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 645833 . This is a "UCCI ID NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 29589 . This is a "AETNA DMO PROV ID" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 117164 . This is a "CIGNA PROV ID" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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