Provider Demographics
NPI:1497221345
Name:MCCUBBIN, BARBARA KEIKO (NP-C)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:KEIKO
Last Name:MCCUBBIN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 PULASKI PARK DR STE 103
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-1472
Mailing Address - Country:US
Mailing Address - Phone:443-725-8737
Mailing Address - Fax:443-725-8816
Practice Address - Street 1:228 7TH ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4306
Practice Address - Country:US
Practice Address - Phone:202-698-0795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN961677363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily