Healthcare Provider Details

I. General information

NPI: 1760571210
Provider Name (Legal Business Name): JOHN RICHARD BARBOUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
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: 703-972-6655
  • Fax: 703-738-6454
Mailing address:
  • Phone: 703-972-6655
  • Fax: 703-738-6454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD040901
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: