Provider Demographics
NPI:1003916164
Name:BARBER, MITCHELL A (DPM)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:A
Last Name:BARBER
Suffix:
Gender:M
Credentials:DPM
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 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
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01305213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
607091/KBU5MIOtherCAREFIRST BC/BS
0001/F751OtherCAREFIRST BC/FEDERAL
U81209Medicare UPIN
00B324M62Medicare PIN