Healthcare Provider Details

I. General information

NPI: 1710940325
Provider Name (Legal Business Name): MARK ALLEN BIRD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 EXECUTIVE DR SUITE C
DANVILLE VA
24541-4160
US

IV. Provider business mailing address

159 EXECUTIVE DR SUITE B
DANVILLE VA
24541-4160
US

V. Phone/Fax

Practice location:
  • Phone: 434-792-5964
  • Fax: 434-792-5971
Mailing address:
  • Phone: 434-792-5964
  • Fax: 434-792-5971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number010123776
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: