Provider Demographics
NPI:1104973221
Name:BARTE, TICONI ANTOINE (DO)
Entity type:Individual
Prefix:DR
First Name:TICONI
Middle Name:ANTOINE
Last Name:BARTE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 OLD DOMINION AVE
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-5323
Mailing Address - Country:US
Mailing Address - Phone:703-471-1219
Mailing Address - Fax:
Practice Address - Street 1:11484 WASHINGTON PLZ W
Practice Address - Street 2:SUITE 300
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-4344
Practice Address - Country:US
Practice Address - Phone:703-787-3219
Practice Address - Fax:703-481-3853
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102050121207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G22085Medicare UPIN
A21774Medicare ID - Type Unspecified