Healthcare Provider Details

I. General information

NPI: 1336692649
Provider Name (Legal Business Name): PHILIP MARTIN BARBER MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 S 17TH ST
WILMINGTON NC
28401-7407
US

IV. Provider business mailing address

PO BOX 20169
ROANOKE VA
24018-0506
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-7074
  • Fax: 910-343-7829
Mailing address:
  • Phone: 540-767-2700
  • Fax: 540-767-2708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License Number2020008449
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberTRN# 23487
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2022-01487
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: