Provider Demographics
NPI:1710385497
Name:BARNES, MARIAN
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:BARNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11040 STARR ROAD
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:NY
Mailing Address - Zip Code:14591
Mailing Address - Country:US
Mailing Address - Phone:585-584-3759
Mailing Address - Fax:
Practice Address - Street 1:45 PRINCE ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1437
Practice Address - Country:US
Practice Address - Phone:585-324-5915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-12
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY604894-1390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program