Healthcare Provider Details

I. General information

NPI: 1811131006
Provider Name (Legal Business Name): BIRVA A STRAUB M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2009
Last Update Date: 06/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PERRYRIDGE RD MEDICAL EDUCATION
GREENWICH CT
06830-4608
US

IV. Provider business mailing address

5 PERRYRIDGE RD MEDICAL EDUCATION
GREENWICH CT
06830-4608
US

V. Phone/Fax

Practice location:
  • Phone: 203-863-3409
  • Fax:
Mailing address:
  • Phone: 203-863-3409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number279549
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: