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NPI Code Detail

MEDICARE: MR. WILLIAM RUSSELL BARTOW JR

MEDICARE: MR. WILLIAM RUSSELL BARTOW JR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant0110000104VA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00068592OTHERALRAILROAD MEDICARE

General Provider Information

NPI Number : 1023069531
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. WILLIAM RUSSELL BARTOW JR
Provider Business Mailing Address
First Line : 2501 PARKERS LN
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22306-3209
Country : US
Telephone Number : 703-664-7218
Fax Number : 703-664-7317
Provider Business Practice Location Address
First Line : 2501 PARKERS LN
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22306-3209
Country : US
Telephone Number : 703-664-7218
Fax Number : 703-664-7317
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2006
Last Update Date : 03/19/2012

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Directions to “ MR. WILLIAM RUSSELL BARTOW JR ” Practice Location

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