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NPI Code Detail

MEDICARE: BARRY FERNANDO, MD AND COLEENE FERNANDO, MD PC

MEDICARE: BARRY FERNANDO, MD AND COLEENE FERNANDO, MD PC
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
1174400000XSpecialist17802AZ

General Provider Information

NPI Number : 1386970531
Entity Type Code : Organization
Provider Name (Legal Business Name) : BARRY FERNANDO, MD AND COLEENE FERNANDO, MD PC
Provider Business Mailing Address
First Line : 2777 E CAMELBACK RD
Second Line : #140
City : PHOENIX
State : AZ
Zip : 85016-4347
Country : US
Telephone Number : 602-956-3596
Fax Number : 602-956-4762
Provider Business Practice Location Address
First Line : 2777 E CAMELBACK RD
Second Line : #140
City : PHOENIX
State : AZ
Zip : 85016-4347
Country : US
Telephone Number : 602-956-3596
Fax Number : 602-956-4762
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : BARRY FERNANDO
Credential : M.D.
Telephone Number : 602-956-3596
Provider Enumeration Date : 10/22/2009
Last Update Date : 02/02/2010

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