1174957005 NPI number — ABIGAIL N. BARDEN PT, DPT

Table of content: RAHIEM BUFORD (NPI 1316586027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174957005 NPI number — ABIGAIL N. BARDEN PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARDEN
Provider First Name:
ABIGAIL
Provider Middle Name:
N.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GUYER
Provider Other First Name:
ABIGAIL
Provider Other Middle Name:
N.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174957005
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
771 PILOT HOUSE DR
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
NEWPORT NEWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23606-1990
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-873-2302
Provider Business Mailing Address Fax Number:
757-873-2306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3510 ANDERSON HWY
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
POWHATAN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23139-5846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-598-2100
Provider Business Practice Location Address Fax Number:
804-598-7624
Provider Enumeration Date:
08/28/2013

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: 225100000X , with the licence number:  2305208283 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: C05954 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1174957005 . This is a "MEDICAID QMB" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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