=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285439703
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GALEN INPATIENT PHYSICIANS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2025
-----------------------------------------------------
Last Update Date | 02/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 56 FRANKLIN ST
-----------------------------------------------------
City | WATERBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06706-1253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-709-6000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2100 POWELL ST STE 400
-----------------------------------------------------
City | EMERYVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94608-1872
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-851-7501
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO & VP
-----------------------------------------------------
Name | DAVID BIRDSALL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 510-350-2600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------