Healthcare Provider Details

I. General information

NPI: 1801285937
Provider Name (Legal Business Name): MATTHEW BARNES PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2015
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18877 JEB STUART HWY
STUART VA
24171-5223
US

IV. Provider business mailing address

1651 N PARHAM RD
RICHMOND VA
23229-4605
US

V. Phone/Fax

Practice location:
  • Phone: 276-694-4466
  • Fax: 276-694-2909
Mailing address:
  • Phone: 804-288-8248
  • Fax: 804-282-6223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110004822
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: