Provider Demographics
NPI:1366466302
Name:BARNES, DAVID WILLIAM (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WILLIAM
Last Name:BARNES
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 1:1306 COTTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-3606
Mailing Address - Country:US
Mailing Address - Phone:215-745-1212
Mailing Address - Fax:215-745-4427
Practice Address - Street 1:1306 COTTMAN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-3606
Practice Address - Country:US
Practice Address - Phone:215-745-1212
Practice Address - Fax:215-745-4427
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-007113-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG03402Medicare UPIN
PA689842Medicare ID - Type Unspecified