Basic Information
Provider Information
NPI: 1003962911
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARFUSS
FirstName: JASON
MiddleName: ROBERT
NamePrefix: MR.
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7818 EDMUNDS WAY
Address2:  
City: ELKRIDGE
State: MD
PostalCode: 210755904
CountryCode: US
TelephoneNumber: 3012634554
FaxNumber:  
Practice Location
Address1: 7600 CARROLL AVE
Address2:  
City: TAKOMA PARK
State: MD
PostalCode: 209126367
CountryCode: US
TelephoneNumber: 3018917600
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/25/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AS0400XC03224MDY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical

No ID Information.


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