Provider Demographics
NPI:1790895241
Name:SIMON, BARRY GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:GEORGE
Last Name:SIMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12605 LINCOLNSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2361
Mailing Address - Country:US
Mailing Address - Phone:301-529-6607
Mailing Address - Fax:
Practice Address - Street 1:1111 20TH ST NW
Practice Address - Street 2:5TH FLOOR
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20526-0001
Practice Address - Country:US
Practice Address - Phone:202-692-1509
Practice Address - Fax:202-692-5118
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2009-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0036758207RP1001X
DCMD17338207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0425490Medicaid
A47724Medicare UPIN
554998P63Medicare ID - Type Unspecified