Healthcare Provider Details

I. General information

NPI: 1861592941
Provider Name (Legal Business Name): MITCHELL A BARBER DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7350 VAN DUSEN RD SUITE 310
LAUREL MD
20707-5264
US

IV. Provider business mailing address

PO BOX 374
MONKTON MD
21111-0374
US

V. Phone/Fax

Practice location:
  • Phone: 301-490-2216
  • Fax: 301-490-6705
Mailing address:
  • Phone: 443-522-9749
  • Fax: 443-522-9725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number01305
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number01305
License Number StateMD

VIII. Authorized Official

Name: MITCHELL A BARBER
Title or Position: PRESIDENT
Credential: DPM
Phone: 301-490-2216