Provider Demographics
NPI:1003873415
Name:BARRIOCANAL, JOSE L (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:L
Last Name:BARRIOCANAL
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 1:220 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-3820
Mailing Address - Country:US
Mailing Address - Phone:302-629-4528
Mailing Address - Fax:302-629-6533
Practice Address - Street 1:220 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-3820
Practice Address - Country:US
Practice Address - Phone:302-629-4528
Practice Address - Fax:302-629-6533
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10000823208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE123427Medicare PIN
DEC48648Medicare UPIN
DE0686050001Medicare NSC