Provider Demographics
NPI:1861592941
Name:MITCHELL A BARBER DPM LLC
Entity type:Organization
Organization Name:MITCHELL A BARBER DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-490-2216
Mailing Address - Street 1:PO BOX 374
Mailing Address - Street 2:
Mailing Address - City:MONKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21111-0374
Mailing Address - Country:US
Mailing Address - Phone:443-522-9749
Mailing Address - Fax:443-522-9725
Practice Address - Street 1:7350 VAN DUSEN RD
Practice Address - Street 2:SUITE 310
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5264
Practice Address - Country:US
Practice Address - Phone:301-490-2216
Practice Address - Fax:301-490-6705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01305332B00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406504200Medicaid
MD406573500Medicaid
F751OtherBC/BS FEDERAL
KBU5MIOtherBC/BS
4691720001Medicare NSC
G00962Medicare PIN
U81209Medicare UPIN