Provider Demographics
NPI:1700501186
Name:BARNETT, PETER CHARLES
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:CHARLES
Last Name:BARNETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7183 SCARLET OAK CT
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-7304
Mailing Address - Country:US
Mailing Address - Phone:513-502-0425
Mailing Address - Fax:513-729-6552
Practice Address - Street 1:1230 ANTHONY LN
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1139
Practice Address - Country:US
Practice Address - Phone:513-502-0425
Practice Address - Fax:513-729-6552
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8305277385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH8305277OtherDODD CONTRACT NUMBER
OH0498311Medicaid