Healthcare Provider Details

I. General information

NPI: 1689519449
Provider Name (Legal Business Name): RANDOLPH E BIRSCH DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5131 RIVER CLUB DR STE 100
SUFFOLK VA
23435-3846
US

IV. Provider business mailing address

5131 RIVER CLUB DR STE 100
SUFFOLK VA
23435-3846
US

V. Phone/Fax

Practice location:
  • Phone: 757-262-7394
  • Fax:
Mailing address:
  • Phone: 757-262-7394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. RANDOLPH BIRSCH
Title or Position: ENDODONTIST
Credential: DMD, MSD
Phone: 757-262-7394