Provider Demographics
NPI:1376771600
Name:BARROSO, JEFFREY MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MATTHEW
Last Name:BARROSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 RACE ST APT 4J
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-2043
Mailing Address - Country:US
Mailing Address - Phone:210-577-9961
Mailing Address - Fax:
Practice Address - Street 1:475 SPRING LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-3918
Practice Address - Country:US
Practice Address - Phone:267-758-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-25
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT196024207ZP0102X, 2084P0800X
PAMD4475742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology