MEDICARE: DR. PAUL BIRNBAUM 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	207N00000X	Dermatology Physician	51938	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447210158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL BIRNBAUM M.D.

Provider Business Mailing Address
First Line	:	2000 WASHINGTON ST
Second Line	:	WHITE 541
City	:	NEWTON LOWER FALLS
State	:	MA
Zip	:	02462-1650
Country	:	US
Telephone Number	:	617-244-0580
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 WASHINGTON ST
Second Line	:	WHITE 541
City	:	NEWTON LOWER FALLS
State	:	MA
Zip	:	02462-1650
Country	:	US
Telephone Number	:	617-244-0580
Fax Number	:

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

Provider Enumeration Date	:	03/25/2006
Last Update Date	:	12/06/2016

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