MEDICARE: DR. CHARLES E BARR M.D.

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
1	207R00000X	Internal Medicine Physician	25MA07288600	NJ

General Provider Information

NPI Number	:	1861627531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES E BARR M.D.

Provider Business Mailing Address
First Line	:	1 DNA WAY
Second Line	:	MAIL STOP 66
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-4918
Country	:	US
Telephone Number	:	650-225-4867
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 DNA WAY
Second Line	:	MAIL STOP 66
City	:	SOUTH SAN FRANCISCO
State	:	CA
Zip	:	94080-4918
Country	:	US
Telephone Number	:	650-225-4867
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2009
Last Update Date	:	05/05/2011

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