Healthcare Provider Details

I. General information

NPI: 1043844046
Provider Name (Legal Business Name): CORBIN BIRD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2020
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 JOHN PAUL JONES CIR STE 202
PORTSMOUTH VA
23708-2199
US

IV. Provider business mailing address

620 JOHN PAUL JONES CIR STE 202
PORTSMOUTH VA
23708-2199
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-3933
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: