Healthcare Provider Details

I. General information

NPI: 1679223218
Provider Name (Legal Business Name): THOMAS BARBA PACHECO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2022
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 CONNECTICUT AVE NW STE 402
WASHINGTON DC
20036-1761
US

IV. Provider business mailing address

3700 MASSACHUSETTS AVE NW APT 419
WASHINGTON DC
20016-5807
US

V. Phone/Fax

Practice location:
  • Phone: 202-630-5705
  • Fax: 329-777-5351
Mailing address:
  • Phone: 202-630-5705
  • Fax: 329-777-5351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD600004193
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: