1861592941 NPI number — MITCHELL A BARBER DPM LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861592941 NPI number — MITCHELL A BARBER DPM LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MITCHELL A BARBER DPM LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1861592941
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 374
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONKTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21111-0374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-522-9749
Provider Business Mailing Address Fax Number:
443-522-9725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7350 VAN DUSEN RD
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
LAUREL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20707-5264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-490-2216
Provider Business Practice Location Address Fax Number:
301-490-6705
Provider Enumeration Date:
09/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BARBER
Authorized Official First Name:
MITCHELL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
301-490-2216

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  01305 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: 01305 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 406504200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 406573500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: F751 . This is a "BC/BS FEDERAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: KBU5MI . This is a "BC/BS" identifier . This identifiers is of the category "OTHER".




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