Healthcare Provider Details

I. General information

NPI: 1679634869
Provider Name (Legal Business Name): BARNETT T GIBBS M.D., FACC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7603 FOREST AVENUE SUITE 202
RICHMOND VA
23229
US

IV. Provider business mailing address

7603 FOREST AVENUE SUITE 202
RICHMOND VA
23229
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-0134
  • Fax: 804-285-5165
Mailing address:
  • Phone: 804-288-0134
  • Fax: 804-285-5165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD063059L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD0075356
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101259014
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: