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NPI Code Detail

MEDICARE: RIVERSIDE NEUROLOGY ASSOCIATES, P.A.

MEDICARE: RIVERSIDE NEUROLOGY ASSOCIATES, P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialistD76344MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12084N0400XOTHERMHTAXONOMY NUMBER

General Provider Information

NPI Number : 1053314260
Entity Type Code : Organization
Provider Name (Legal Business Name) : RIVERSIDE NEUROLOGY ASSOCIATES, P.A.
Provider Business Mailing Address
First Line : 560 RIVERSIDE DR
Second Line : SUITE B204
City : SALISBURY
State : MD
Zip : 21801-4700
Country : US
Telephone Number : 410-546-5722
Fax Number : 410-546-5851
Provider Business Practice Location Address
First Line : 560 RIVERSIDE DR
Second Line : STE B204
City : SALISBURY
State : MD
Zip : 21801-4703
Country : US
Telephone Number : 410-546-5722
Fax Number : 410-546-5851
Authorized Official
Title or Position : PHYSICIAN
Name : DR. RICHARD E BIRD
Credential : M.D.
Telephone Number : 410-546-5722
Provider Enumeration Date : 05/23/2005
Last Update Date : 05/25/2011

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