Healthcare Provider Details

I. General information

NPI: 1396135802
Provider Name (Legal Business Name): MATTHEW BARKER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 JAHNKE RD
RICHMOND VA
23225-4017
US

IV. Provider business mailing address

107 TURKEY HILL CT
STROUDSBURG PA
18360-6870
US

V. Phone/Fax

Practice location:
  • Phone: 804-320-3911
  • Fax:
Mailing address:
  • Phone: 240-494-6220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2156
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110-004850
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: