Provider Demographics
NPI:1053459487
Name:BARBERA, PAUL THOMAS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:THOMAS
Last Name:BARBERA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:703 S CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4026
Mailing Address - Country:US
Mailing Address - Phone:410-276-0176
Mailing Address - Fax:410-732-1890
Practice Address - Street 1:703 S CLINTON ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4026
Practice Address - Country:US
Practice Address - Phone:410-276-0176
Practice Address - Fax:410-732-1890
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD37708207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE30371Medicare UPIN