Provider Demographics
NPI:1952422131
Name:SIDDLE, BARBARA GAY (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:GAY
Last Name:SIDDLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:BARBARA
Other - Middle Name:SIDDLE
Other - Last Name:MATHESON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11301 WILLOW BOTTOM DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-1070
Mailing Address - Country:US
Mailing Address - Phone:443-283-8414
Mailing Address - Fax:
Practice Address - Street 1:8640 GUILFORD RD
Practice Address - Street 2:SUITE 252
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2655
Practice Address - Country:US
Practice Address - Phone:410-312-7250
Practice Address - Fax:410-312-7298
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1652103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG857Medicare ID - Type Unspecified