Healthcare Provider Details

I. General information

NPI: 1174817431
Provider Name (Legal Business Name): DANIELLE N. BIRMINGHAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE SORENSON M.D.

II. Dates (important events)

Enumeration Date: 06/04/2011
Last Update Date: 11/19/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 LAKE AVE N
WORCESTER MA
01655-0002
US

IV. Provider business mailing address

PO BOX 415348
BOSTON MA
02241-5348
US

V. Phone/Fax

Practice location:
  • Phone: 508-334-3271
  • Fax: 508-856-5911
Mailing address:
  • Phone: 800-225-8885
  • Fax: 508-334-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number268846
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number268846
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: