Provider Demographics
NPI:1841320728
Name:SUNDIN, REPS BARNES (MD)
Entity type:Individual
Prefix:DR
First Name:REPS
Middle Name:BARNES
Last Name:SUNDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7611 FOREST AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4946
Mailing Address - Country:US
Mailing Address - Phone:804-290-0909
Mailing Address - Fax:804-290-0333
Practice Address - Street 1:7611 FOREST AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4946
Practice Address - Country:US
Practice Address - Phone:804-290-0909
Practice Address - Fax:804-290-0333
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101247125208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1841320728Medicaid