Provider Demographics
NPI:1043345861
Name:LANDESMAN, BARBARA ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:ANNE
Last Name:LANDESMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 ONYX CIR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-7805
Mailing Address - Country:US
Mailing Address - Phone:303-776-5298
Mailing Address - Fax:
Practice Address - Street 1:1511 ONYX CIR
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-7805
Practice Address - Country:US
Practice Address - Phone:303-776-5298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93333174400000X
NMTM2010-01522084N0400X
CODR00527142084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No174400000XOther Service ProvidersSpecialist
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA93333OtherLICENSE
CA00933330Medicaid
NMTM2010-0152OtherNM
CAA93333OtherLICENSE
NMTM2010-0152OtherNM