Provider Demographics
NPI:1851338040
Name:BARNES, CEDRIC TERRIELL (DO)
Entity Type:Individual
Prefix:
First Name:CEDRIC
Middle Name:TERRIELL
Last Name:BARNES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-0337
Mailing Address - Country:US
Mailing Address - Phone:302-424-3900
Mailing Address - Fax:302-424-8327
Practice Address - Street 1:119 NEUROLOGY WAY
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-5368
Practice Address - Country:US
Practice Address - Phone:302-424-3900
Practice Address - Fax:302-424-8327
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC20006015207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001147603Medicaid
G54950Medicare UPIN
DEG02391S01Medicare PIN