Provider Demographics
NPI:1275681736
Name:BARROSO, RAUL (DO)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:
Last Name:BARROSO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2137 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-6806
Mailing Address - Country:US
Mailing Address - Phone:434-404-7200
Mailing Address - Fax:434-385-8616
Practice Address - Street 1:2137 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-6806
Practice Address - Country:US
Practice Address - Phone:434-404-7200
Practice Address - Fax:434-385-8616
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102206665208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021616800Medicaid