1689051567 NPI number — CHELSEA RENE BARNES PHYSICIAN ASSISTANT

Table of content: CHELSEA RENE BARNES PHYSICIAN ASSISTANT (NPI 1689051567)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689051567 NPI number — CHELSEA RENE BARNES PHYSICIAN ASSISTANT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARNES
Provider First Name:
CHELSEA
Provider Middle Name:
RENE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASSISTANT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMTIH
Provider Other First Name:
CHELSEA
Provider Other Middle Name:
RENE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689051567
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3908 SOUTHERN AVE SE
Provider Second Line Business Mailing Address:
APT#301
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20020-1127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-825-9575
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5401 OLD COURT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RANDALLSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21133-5103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-521-2200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/30/2015

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: 363AS0400X , with the licence number:  1141249 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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