Provider Demographics
NPI:1881688505
Name:BARTON, CHARLES DENNIS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DENNIS
Last Name:BARTON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 W EL CAMINO REAL
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6201
Mailing Address - Country:US
Mailing Address - Phone:650-934-3546
Mailing Address - Fax:
Practice Address - Street 1:39650 LIBERTY ST
Practice Address - Street 2:SUITE 310
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2223
Practice Address - Country:US
Practice Address - Phone:510-498-2890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD412362084F0202X
GA0789262084P0800X
CAC539182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG16565Medicare UPIN