Provider Demographics
NPI:1972558922
Name:BARAKOS, JEROME A (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:A
Last Name:BARAKOS
Suffix:
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:PO BOX 6102
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94948-6102
Mailing Address - Country:US
Mailing Address - Phone:415-884-9125
Mailing Address - Fax:
Practice Address - Street 1:1101 VAN NESS AVE FL 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-6919
Practice Address - Country:US
Practice Address - Phone:415-600-3232
Practice Address - Fax:415-447-6335
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG630972085R0202X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA300130264OtherRAILROAD MEDICARE
CA00G630970Medicaid
CA300130289OtherRAILROAD MEDICARE
CA300130290OtherRAILROAD MEDICARE
CAAU597ZMedicare PIN
CA300130264OtherRAILROAD MEDICARE
CA00G630970Medicare PIN
CAAU597WMedicare PIN
CAAU597YMedicare PIN
CAAU597XMedicare PIN