Healthcare Provider Details

I. General information

NPI: 1073987954
Provider Name (Legal Business Name): MOHAMED S BARRY CRNP-FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2015
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 ROCKVILLE PIKE
ROCKVILLE MD
20852-1136
US

IV. Provider business mailing address

799 ROCKVILLE PIKE
ROCKVILLE MD
20852-1136
US

V. Phone/Fax

Practice location:
  • Phone: 301-340-2683
  • Fax:
Mailing address:
  • Phone: 301-340-2683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN168133
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: