Provider Demographics
NPI:1598731200
Name:BARNES, ELENA V (MD)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:V
Last Name:BARNES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-361-5632
Mailing Address - Fax:
Practice Address - Street 1:1223 GATEWAY DR STE 2H
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2607
Practice Address - Country:US
Practice Address - Phone:321-361-5632
Practice Address - Fax:321-722-1879
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83862207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47988XOtherMEDICARE
FL273515600Medicaid
P01164036OtherRRMR
DE47988XOtherMEDICARE
P01164036OtherRRMR