Provider Demographics
NPI:1396733325
Name:BARCLAY, DAVID M (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:BARCLAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:166 W LEHIGH AVE
Mailing Address - Street 2:#4
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19133-3849
Mailing Address - Country:US
Mailing Address - Phone:215-634-5272
Mailing Address - Fax:215-634-5271
Practice Address - Street 1:166 W LEHIGH AVE
Practice Address - Street 2:#4
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133-3849
Practice Address - Country:US
Practice Address - Phone:215-634-5272
Practice Address - Fax:215-634-5271
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2011-08-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD061309L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016309100002Medicaid
PA0016309100002Medicaid
E96316Medicare UPIN