Provider Demographics
NPI:1588618151
Name:BARNES FAMILY PRACTICE
Entity Type:Organization
Organization Name:BARNES FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CEDRIC
Authorized Official - Middle Name:TERRIELL
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:302-424-3900
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-0337
Mailing Address - Country:US
Mailing Address - Phone:302-424-3900
Mailing Address - Fax:302-424-8327
Practice Address - Street 1:800 AIRPORT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-6421
Practice Address - Country:US
Practice Address - Phone:302-424-3900
Practice Address - Fax:302-424-8327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2002104707207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000015417Medicaid
DE1000015417Medicaid