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General NPI Number Information
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NPI Number | 1053314260
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Entity Type | Organization
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Legal Business Name | RIVERSIDE NEUROLOGY ASSOCIATES, P.A.
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Dates
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Enumeration Date | 05/23/2005
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Last Update Date | 05/25/2011
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Provider Practice Location Address
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Address Line | 560 RIVERSIDE DR STE B204
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City | SALISBURY
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State | MD
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Zip | 21801-4703
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Country | US
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Telephone | 410-546-5722
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Fax | 410-546-5851
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Provider Business Mailing Address
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Address Line | 560 RIVERSIDE DR SUITE B204
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City | SALISBURY
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State | MD
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Zip | 21801-4700
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Country | US
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Telephone | 410-546-5722
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Fax | 410-546-5851
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. RICHARD E BIRD
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Credential | M.D.
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Telephone | 410-546-5722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | D76344
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License Number State | MD
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