Provider Demographics
NPI:1477751824
Name:EDWARD BARBANO, M.D., P.C.
Entity Type:Organization
Organization Name:EDWARD BARBANO, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:BARBANO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:703-764-2111
Mailing Address - Street 1:8996 BURKE LAKE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1607
Mailing Address - Country:US
Mailing Address - Phone:703-764-2111
Mailing Address - Fax:703-764-1418
Practice Address - Street 1:8996 BURKE LAKE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1607
Practice Address - Country:US
Practice Address - Phone:703-764-2111
Practice Address - Fax:703-764-1418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049038207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5828520Medicaid
VAG00362Medicare ID - Type Unspecified
VAF58639Medicare UPIN