Healthcare Provider Details

I. General information

NPI: 1366951618
Provider Name (Legal Business Name): BARBOUR PLASTIC SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8316 ARLINGTON BLVD STE 514
FAIRFAX VA
22031-5216
US

IV. Provider business mailing address

8316 ARLINGTON BLVD STE 514
FAIRFAX VA
22031-5216
US

V. Phone/Fax

Practice location:
  • Phone: 703-587-0857
  • Fax: 703-587-0857
Mailing address:
  • Phone: 703-587-0857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number010125284
License Number StateVA

VIII. Authorized Official

Name: DR. JOHN RICHARD BARBOUR
Title or Position: PRESIDENT AND CMO
Credential: MD
Phone: 703-728-3693