Provider Demographics
NPI:1386309227
Name:BARNES, EVAN JERROLD
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:JERROLD
Last Name:BARNES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 STANIFORD ST # 50-9
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2517
Mailing Address - Country:US
Mailing Address - Phone:617-726-4900
Mailing Address - Fax:617-228-6306
Practice Address - Street 1:50 STANIFORD ST # 50-9
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2517
Practice Address - Country:US
Practice Address - Phone:617-726-4900
Practice Address - Fax:617-228-6306
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program