Provider Demographics
NPI:1770763492
Name:BARBOUR, JANICE
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:BARBOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 PARKSIDE AVE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-4746
Mailing Address - Country:US
Mailing Address - Phone:215-879-4023
Mailing Address - Fax:215-879-3405
Practice Address - Street 1:4950 PARKSIDE AVE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-4746
Practice Address - Country:US
Practice Address - Phone:215-879-4023
Practice Address - Fax:215-879-3405
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC007404L171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor