Provider Demographics
NPI:1861467953
Name:VANFOSSEN, BARBARA J (DPM)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:J
Last Name:VANFOSSEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1334 SHERIDAN DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3956
Mailing Address - Country:US
Mailing Address - Phone:740-687-9345
Mailing Address - Fax:740-689-1459
Practice Address - Street 1:1334 SHERIDAN DR
Practice Address - Street 2:SUITE 4
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3956
Practice Address - Country:US
Practice Address - Phone:740-687-9345
Practice Address - Fax:740-689-1459
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003139V213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2141953Medicaid
OH2141953Medicaid
OH311666298OtherTAX ID NUMBER
OHVA0878282Medicare PIN
OH2141953Medicaid