Healthcare Provider Details

I. General information

NPI: 1639110158
Provider Name (Legal Business Name): RANDY B. BARNETT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10551 DECATUR RD SUITE 200
PHILADELPHIA PA
19154-3800
US

IV. Provider business mailing address

10551 DECATUR RD SUITE 200
PHILADELPHIA PA
19154-3800
US

V. Phone/Fax

Practice location:
  • Phone: 215-637-6800
  • Fax: 215-637-6984
Mailing address:
  • Phone: 215-637-6800
  • Fax: 215-637-6984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS007493L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License NumberOS007493L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: