Provider Demographics
NPI:1437142593
Name:FABIUS, BARRY M (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:M
Last Name:FABIUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12265 TOWNSEND RD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-1201
Mailing Address - Country:US
Mailing Address - Phone:215-856-1009
Mailing Address - Fax:215-856-1020
Practice Address - Street 1:8580 VERREE RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-1370
Practice Address - Country:US
Practice Address - Phone:215-214-2891
Practice Address - Fax:215-214-2894
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036113E207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01219267Medicaid
E13026Medicare UPIN
PA01219267Medicaid