Provider Demographics
NPI:1417115304
Name:BARNETT, CHANNING RACHEL (MD)
Entity Type:Individual
Prefix:
First Name:CHANNING
Middle Name:RACHEL
Last Name:BARNETT
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 1:7100 W CAMINO REAL STE 301
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-5510
Mailing Address - Country:US
Mailing Address - Phone:561-717-2277
Mailing Address - Fax:561-300-8930
Practice Address - Street 1:7100 W CAMINO REAL STE 301
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5510
Practice Address - Country:US
Practice Address - Phone:561-717-2277
Practice Address - Fax:561-948-5915
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236784207N00000X
FLME117987207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHZ888ZOtherMEDICARE PTAN