Provider Demographics
NPI:1568562072
Name:PETTY, BARBARA E (NP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:E
Last Name:PETTY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17334
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-1334
Mailing Address - Country:US
Mailing Address - Phone:703-729-9220
Mailing Address - Fax:703-858-3529
Practice Address - Street 1:19415 DEERFIELD AVE
Practice Address - Street 2:SUITE 213
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-8452
Practice Address - Country:US
Practice Address - Phone:703-729-9220
Practice Address - Fax:703-858-3529
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X
VA0024169385363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3902500Medicare PIN
TN3902501Medicare PIN
TNP16097Medicare UPIN