Provider Demographics
NPI:1558340190
Name:BARLOW, TANNEISHA S (MD)
Entity Type:Individual
Prefix:MS
First Name:TANNEISHA
Middle Name:S
Last Name:BARLOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4414 LAKE BOONE TRL
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7513
Mailing Address - Country:US
Mailing Address - Phone:919-788-4444
Mailing Address - Fax:919-788-4464
Practice Address - Street 1:4414 LAKE BOONE TRL
Practice Address - Street 2:SUITE 205
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7513
Practice Address - Country:US
Practice Address - Phone:919-788-4444
Practice Address - Fax:919-788-4464
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2005-1261207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2046761AOtherMEDICARE
NC141G4OtherBCBS OF NC
NCI45208Medicare UPIN