MEDICARE: DR. BARBARA DOUGLAS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	MA67410	NJ

General Provider Information

NPI Number	:	1417925124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARBARA DOUGLAS M.D.

Provider Business Mailing Address
First Line	:	7 GEORGE BINGHAM WAY
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-7223
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	92 BRICK RD
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-2177
Country	:	US
Telephone Number	:	856-809-0689
Fax Number	:	856-324-9006

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	10/16/2016

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