Provider Demographics
NPI:1245212463
Name:BARTRAM, LOU GENE (MD)
Entity Type:Individual
Prefix:
First Name:LOU
Middle Name:GENE
Last Name:BARTRAM
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 1:85 SANGER'S LANE
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-6719
Mailing Address - Country:US
Mailing Address - Phone:540-887-3200
Mailing Address - Fax:540-887-3240
Practice Address - Street 1:85 SANGER'S LANE
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-6719
Practice Address - Country:US
Practice Address - Phone:540-887-3200
Practice Address - Fax:540-887-3240
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010390192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945166Medicaid
VA085901MOtherSENTAVA
VA183985OtherANTHEM
E41856Medicare UPIN
VAC00836Medicare ID - Type Unspecified