Provider Demographics
NPI:1649303124
Name:BARBER, ANN M (MD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:M
Last Name:BARBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 SOUTH MARION AVE
Mailing Address - Street 2:VAMC - LAKE CITY
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-5808
Mailing Address - Country:US
Mailing Address - Phone:212-399-3421
Mailing Address - Fax:212-399-3932
Practice Address - Street 1:619 SOUTH MARION AVE
Practice Address - Street 2:VAMC - LAKE CITY
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-5808
Practice Address - Country:US
Practice Address - Phone:212-399-3421
Practice Address - Fax:212-399-3932
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205409207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6087728Medicaid
PA07205224OtherMEDICAL ASSISTANCE PROGM
MD205971100Medicaid
PA07205224OtherMEDICAL ASSISTANCE PROGM
DCF45173Medicare UPIN