Basic Information
Provider Information | |||||||||
NPI: | 1265484109 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BARNES | ||||||||
FirstName: | ROBERT | ||||||||
MiddleName: | B | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1605 N CEDAR CREST BLVD | ||||||||
Address2: | SUITE 110B | ||||||||
City: | ALLENTOWN | ||||||||
State: | PA | ||||||||
PostalCode: | 181042351 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6109731410 | ||||||||
FaxNumber: | 6109731449 | ||||||||
Practice Location | |||||||||
Address1: | 723 CHESTNUT ST | ||||||||
Address2: |   | ||||||||
City: | EMMAUS | ||||||||
State: | PA | ||||||||
PostalCode: | 180492017 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6109674830 | ||||||||
FaxNumber: | 4844034017 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/17/2006 | ||||||||
LastUpdateDate: | 08/12/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS011102L | PA | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 000000146356 | 01 | PA | UNISON AB | OTHER | P00155528 | 01 | PA | PALMETTO RR | OTHER | 50022271 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 0018507440001 | 05 | PA |   | MEDICAID | 1314436 | 01 | PA | HIGHMARK PA BLUE SHIELD | OTHER |