Provider Demographics
NPI:1629008024
Name:BARNES, ROBERT DOUGLASS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DOUGLASS
Last Name:BARNES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1302 MINNICH RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:NEW HAVEN
Mailing Address - State:IN
Mailing Address - Zip Code:46774-2052
Mailing Address - Country:US
Mailing Address - Phone:260-493-6508
Mailing Address - Fax:260-493-6509
Practice Address - Street 1:1302 MINNICH RD
Practice Address - Street 2:SUITE 4
Practice Address - City:NEW HAVEN
Practice Address - State:IN
Practice Address - Zip Code:46774-2052
Practice Address - Country:US
Practice Address - Phone:260-493-6508
Practice Address - Fax:260-493-6509
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026191A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100054870Medicaid
INC24212Medicare UPIN
INM400029055Medicare PIN