=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366517153
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BIRGER STEVEN BENTSEN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2006
-----------------------------------------------------
Last Update Date | 05/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1908 MEETING CT
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28401-6631
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-815-0260
-----------------------------------------------------
Fax | 910-763-3311
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10741 TREGO TRL
-----------------------------------------------------
City | RALEIGH
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27614-9660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-524-7100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084A0401X
-----------------------------------------------------
Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
-----------------------------------------------------
License Number | 28461
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 28461
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------