Provider Demographics
NPI:1376548677
Name:BARBARITO, NANCY G (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:G
Last Name:BARBARITO
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 1:1 PROFESSIONAL PARK DR
Mailing Address - Street 2:STE 21
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6589
Mailing Address - Country:US
Mailing Address - Phone:423-926-5111
Mailing Address - Fax:
Practice Address - Street 1:1 PROFESSIONAL PARK DR
Practice Address - Street 2:STE 21
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6589
Practice Address - Country:US
Practice Address - Phone:423-926-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28306207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3816330Medicaid
TNG52769Medicare UPIN
TN3816330Medicaid