MEDICARE: DR. RICHARD EARL BIRD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	D0022132	MD
2	2084N0400X	Neurology Physician	MD458990	PA

General Provider Information

NPI Number	:	1265435473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD EARL BIRD M.D.

Provider Business Mailing Address
First Line	:	560 RIVERSIDE DR
Second Line	:	SUITE B204
City	:	SALISBURY
State	:	MD
Zip	:	21801-4700
Country	:	US
Telephone Number	:	410-546-5722
Fax Number	:

Provider Business Practice Location Address
First Line	:	560 RIVERSIDE DRIVE
Second Line	:	SUITE B204
City	:	SALISBURY
State	:	MD
Zip	:	21801
Country	:	US
Telephone Number	:	410-546-5722
Fax Number	:	410-546-5851

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	10/18/2016

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