Healthcare Provider Details

I. General information

NPI: 1538421433
Provider Name (Legal Business Name): DANIEL BIRNBAUM D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 OLD YORK RD KLEIN 404
PHILADELPHIA PA
19141-3030
US

IV. Provider business mailing address

7400 MERTON MINTER ST
SAN ANTONIO TX
78229-4404
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-7190
  • Fax: 215-456-7308
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License NumberOS019440
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: