Provider Demographics
NPI:1417901414
Name:BARRERE, PHILIP WILLIAM JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:WILLIAM
Last Name:BARRERE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13057 FITZWATER DR
Mailing Address - Street 2:
Mailing Address - City:NOKESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20181-2227
Mailing Address - Country:US
Mailing Address - Phone:540-660-1620
Mailing Address - Fax:202-827-7867
Practice Address - Street 1:13057 FITZWATER DR
Practice Address - Street 2:
Practice Address - City:NOKESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20181-2227
Practice Address - Country:US
Practice Address - Phone:540-660-1620
Practice Address - Fax:202-827-7867
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD039138208D00000X
VA0101239371208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC160857YCBFMedicare UPIN