Healthcare Provider Details

I. General information

NPI: 1447368410
Provider Name (Legal Business Name): DANIEL CHARLES BIRNBAUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND ST DEPARTMENT OF NEUROLOGY
OAKLAND CA
94609-1809
US

IV. Provider business mailing address

747 52ND ST DEPARTMENT OF NEUROLOGY
OAKLAND CA
94609-1809
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3590
  • Fax: 510-601-3974
Mailing address:
  • Phone: 510-428-3590
  • Fax: 510-601-3974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberG49267
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: