Provider Demographics
NPI:1386970531
Name:BARRY FERNANDO, MD AND COLEENE FERNANDO, MD PC
Entity type:Organization
Organization Name:BARRY FERNANDO, MD AND COLEENE FERNANDO, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-956-3596
Mailing Address - Street 1:2777 E CAMELBACK RD
Mailing Address - Street 2:#140
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4347
Mailing Address - Country:US
Mailing Address - Phone:602-956-3596
Mailing Address - Fax:602-956-4762
Practice Address - Street 1:2777 E CAMELBACK RD
Practice Address - Street 2:#140
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4347
Practice Address - Country:US
Practice Address - Phone:602-956-3596
Practice Address - Fax:602-956-4762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17802174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty