Basic Information
| Provider Information | |||||||||
| NPI: | 1861428849 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARNES | ||||||||
| FirstName: | HALDOR | ||||||||
| MiddleName: | P. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1500 | ||||||||
| Address2: | |||||||||
| City: | MASHPEE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026491500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084774282 | ||||||||
| FaxNumber: | 5085396134 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 INDUSTRIAL DRIVE | ||||||||
| Address2: | SUITE 100 MASHPEE FAMILY MEDICINE | ||||||||
| City: | MASHPEE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084774282 | ||||||||
| FaxNumber: | 5085396134 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 03/10/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 38308 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 016465 | ME | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00230567 | 01 | ME | RAILROAD MEDICARE | OTHER | 431553599 | 05 | ME | MEDICAID |