Healthcare Provider Details

I. General information

NPI: 1881649804
Provider Name (Legal Business Name): JUANCARLOS BARRA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3133 NEW GERMANY RD SUITE 62
EBENSBURG PA
15931-4348
US

IV. Provider business mailing address

3133 NEW GERMANY RD SUITE 62
EBENSBURG PA
15931-4348
US

V. Phone/Fax

Practice location:
  • Phone: 814-472-2660
  • Fax: 814-472-2666
Mailing address:
  • Phone: 814-472-2660
  • Fax: 814-472-2666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC005672
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: