Healthcare Provider Details

I. General information

NPI: 1871812800
Provider Name (Legal Business Name): DOUGLAS BARNES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2010
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7410 DULANY DR
MC LEAN VA
22101-2715
US

IV. Provider business mailing address

7410 DULANY DR
MC LEAN VA
22101-2715
US

V. Phone/Fax

Practice location:
  • Phone: 703-847-5657
  • Fax:
Mailing address:
  • Phone: 703-847-5657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101261676
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number244919
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number244919
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101261676
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: