Basic Information
| Provider Information | |||||||||
| NPI: | 1447239405 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARSANTI | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1501 MAPLE AVE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232262553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042887246 | ||||||||
| FaxNumber: | 8042887245 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 MAPLE AVE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232262553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042887246 | ||||||||
| FaxNumber: | 8042887245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 10/29/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 0101044553 | VA | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 431694 | 01 | VA | ANTHEM | OTHER | 050074938 | 01 | VA | RAILROAD MEDICARE | OTHER |