Healthcare Provider Details

I. General information

NPI: 1487732608
Provider Name (Legal Business Name): MATTHEW THOMAS BARNABY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 2ND ST SW SUITE 5314
WASHINGTON DC
20593-0002
US

IV. Provider business mailing address

223A LANCE DR
SITKA AK
99835-9749
US

V. Phone/Fax

Practice location:
  • Phone: 202-267-0801
  • Fax:
Mailing address:
  • Phone: 907-966-5476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: