Healthcare Provider Details

I. General information

NPI: 1538409503
Provider Name (Legal Business Name): DAVID W BARNES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2013
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 COTTMAN AVE
PHILADELPHIA PA
19111-3606
US

IV. Provider business mailing address

1306 COTTMAN AVE
PHILADELPHIA PA
19111-3606
US

V. Phone/Fax

Practice location:
  • Phone: 215-745-1212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID W BARNES
Title or Position: PHYSICIAN
Credential: DPM
Phone: 215-742-1212