Provider Demographics
NPI:1881649804
Name:BARRA, JUANCARLOS (DPM)
Entity Type:Individual
Prefix:
First Name:JUANCARLOS
Middle Name:
Last Name:BARRA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3133 NEW GERMANY RD
Mailing Address - Street 2:SUITE 62
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-4348
Mailing Address - Country:US
Mailing Address - Phone:814-472-2660
Mailing Address - Fax:814-472-2666
Practice Address - Street 1:3133 NEW GERMANY RD
Practice Address - Street 2:SUITE 62
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-4348
Practice Address - Country:US
Practice Address - Phone:814-472-2660
Practice Address - Fax:814-472-2666
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005672213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist