Provider Demographics
NPI:1407802572
Name:SHMOOKLER, BARRY MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:MICHAEL
Last Name:SHMOOKLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:753 JOHNNIE DODDS BLVD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3054
Mailing Address - Country:US
Mailing Address - Phone:843-284-3400
Mailing Address - Fax:843-284-3401
Practice Address - Street 1:3600 JOSEPH SIEWICK DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1709
Practice Address - Country:US
Practice Address - Phone:703-391-3654
Practice Address - Fax:703-391-3049
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0021961207ZD0900X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0021961OtherMD MEDICAL LICENSE #
DCMD13872OtherDC MEDICAL LICENSE #
DCMD13872OtherDC MEDICAL LICENSE #
AS8058338OtherDEA REGISTRATION #