Provider Demographics
NPI:1861428849
Name:BARNES, HALDOR P (MD)
Entity type:Individual
Prefix:
First Name:HALDOR
Middle Name:P
Last Name:BARNES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1500
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-1500
Mailing Address - Country:US
Mailing Address - Phone:508-477-4282
Mailing Address - Fax:508-539-6134
Practice Address - Street 1:5 INDUSTRIAL DRIVE
Practice Address - Street 2:SUITE 100 MASHPEE FAMILY MEDICINE
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649
Practice Address - Country:US
Practice Address - Phone:508-477-4282
Practice Address - Fax:508-539-6134
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA38308207Q00000X
ME016465207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEP00230567OtherRAILROAD MEDICARE
ME431553599Medicaid
MEME0576Medicare ID - Type Unspecified
ME431553599Medicaid