Basic Information
| Provider Information | |||||||||
| NPI: | 1881689826 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WERTHEIMER | ||||||||
| FirstName: | BARRY | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1150 VARNUM ST NE FL HALL1 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200172104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028544812 | ||||||||
| FaxNumber: | 2028547825 | ||||||||
| Practice Location | |||||||||
| Address1: | 1150 VARNUM ST NE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200172104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028544041 | ||||||||
| FaxNumber: | 2028544034 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2005 | ||||||||
| LastUpdateDate: | 02/19/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 0101046714 | VA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | MD19158 | DC | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | D41716 | MD | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 591901100 | 05 | MD | MEDICAID | 050044182 | 01 | MD | RAILROAD MEDICARE | OTHER |