Healthcare Provider Details

I. General information

NPI: 1629005798
Provider Name (Legal Business Name): THOMAS L BARNES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 05/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 CREEK CROSSING BLVD
HAINESPORT NJ
08036-2766
US

IV. Provider business mailing address

40 LAKE CENTER DRIVE 401 ROUTE 73 NORTH SUITE 201A
MARLTON NJ
08053-3425
US

V. Phone/Fax

Practice location:
  • Phone: 609-267-1004
  • Fax: 609-267-1044
Mailing address:
  • Phone: 856-355-0340
  • Fax: 856-355-0346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMA40138
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: