Healthcare Provider Details

I. General information

NPI: 1407802572
Provider Name (Legal Business Name): BARRY MICHAEL SHMOOKLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 JOSEPH SIEWICK DR
FAIRFAX VA
22033-1709
US

IV. Provider business mailing address

753 JOHNNIE DODDS BLVD
MT PLEASANT SC
29464-3054
US

V. Phone/Fax

Practice location:
  • Phone: 703-391-3654
  • Fax: 703-391-3049
Mailing address:
  • Phone: 843-284-3400
  • Fax: 843-284-3401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberD0021961
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberD0021961
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: