1417919861 NPI number — DAVID BIRCH D.O.

Table of content: (NPI 1417919861)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417919861 NPI number — DAVID BIRCH D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID BIRCH D.O.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417919861
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1602 NEWPORT GAP PIKE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19808-6208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-633-5740
Provider Business Mailing Address Fax Number:
302-633-5844

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19160 COASTAL HWY
Provider Second Line Business Practice Location Address:
UNIT A
Provider Business Practice Location Address City Name:
REHOBOTH BEACH
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19971-6110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-644-0714
Provider Business Practice Location Address Fax Number:
302-644-0716
Provider Enumeration Date:
04/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BIRCH
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
302-644-0714

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  C20002893 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 080010983 . This is a "PALMETTO GBA" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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