Provider Demographics
NPI:1639110158
Name:BARNETT, RANDY B (DO)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:B
Last Name:BARNETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10551 DECATUR RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-3800
Mailing Address - Country:US
Mailing Address - Phone:215-637-6800
Mailing Address - Fax:215-637-6984
Practice Address - Street 1:10551 DECATUR RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-3800
Practice Address - Country:US
Practice Address - Phone:215-637-6800
Practice Address - Fax:215-637-6984
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS007493L207Q00000X, 207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F39050Medicare UPIN