Provider Demographics
NPI:1851752703
Name:BARKSDALE, ALICIA
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:BARKSDALE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELEASIA
Other - Middle Name:
Other - Last Name:BARKSDALE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3825 GREENSPRING AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-1310
Mailing Address - Country:US
Mailing Address - Phone:443-923-7768
Mailing Address - Fax:
Practice Address - Street 1:3825 GREENSPRING AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1310
Practice Address - Country:US
Practice Address - Phone:443-923-7768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-18
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist