Provider Demographics
NPI:1306209473
Name:BARLOW, JON BLEDSOE III (PA)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:BLEDSOE
Last Name:BARLOW
Suffix:III
Gender:M
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 79777
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0777
Mailing Address - Country:US
Mailing Address - Phone:434-654-7794
Mailing Address - Fax:434-654-7752
Practice Address - Street 1:595 MARTHA JEFFERSON DR STE 180
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-4669
Practice Address - Country:US
Practice Address - Phone:434-654-5575
Practice Address - Fax:434-654-5574
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2021-06-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110-005310363A00000X
VA0110005310363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant