Provider Demographics
NPI:1730593435
Name:BARKATULLAH, NOAMAN
Entity type:Individual
Prefix:
First Name:NOAMAN
Middle Name:
Last Name:BARKATULLAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33455 6TH AVE S STE 2C
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:253-308-2109
Practice Address - Street 1:33455 6TH AVE S STE 2C
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6074
Practice Address - Country:US
Practice Address - Phone:253-367-0502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2078363A00000X
WAPA60531551363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant