Provider Demographics
NPI:1033293683
Name:BARROW, MAMIE VIRGINIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MAMIE
Middle Name:VIRGINIA
Last Name:BARROW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VIRGINIA
Other - Middle Name:
Other - Last Name:BARROW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1644 BENTON CT
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-5101
Mailing Address - Country:US
Mailing Address - Phone:310-559-3525
Mailing Address - Fax:
Practice Address - Street 1:757 WESTWOOD PLZ RM 3108C
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-8358
Practice Address - Country:US
Practice Address - Phone:310-267-9128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52986208000000X
IL036-108575208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL361-08575Medicaid
ILH74362Medicare UPIN