Provider Demographics
NPI:1861451973
Name:BARSOUM, JANINE M (DO)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:M
Last Name:BARSOUM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 CENTRAL AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-3265
Mailing Address - Country:US
Mailing Address - Phone:231-343-7558
Mailing Address - Fax:
Practice Address - Street 1:325 CENTRAL AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-3219
Practice Address - Country:US
Practice Address - Phone:106-251-9433
Practice Address - Fax:610-251-9539
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013258207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017562900003Medicaid
MIJB016302Medicare UPIN