Healthcare Provider Details

I. General information

NPI: 1073849113
Provider Name (Legal Business Name): OLIVER BARKLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2009
Last Update Date: 01/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COLCHESTER AVE 205WP1
BURLINGTON VT
05401-1473
US

IV. Provider business mailing address

111 COLCHESTER AVE 205WP1
BURLINGTON VT
05401-1473
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-3982
  • Fax:
Mailing address:
  • Phone: 802-847-3982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: