MEDICARE: MRS. THERESA SABRINA BIRARDI D.O.

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	207Q00000X	Family Medicine Physician	OS015282	PA
2	207V00000X	Obstetrics & Gynecology Physician	OT012071	PA
3	207Q00000X	Family Medicine Physician	C2-0013225	DE

General Provider Information

NPI Number	:	1881899300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. THERESA SABRINA BIRARDI D.O.

Provider Business Mailing Address
First Line	:	2401 PHILADELPHIA PIKE
Second Line	:
City	:	CLAYMONT
State	:	DE
Zip	:	19703-2430
Country	:	US
Telephone Number	:	302-428-4110
Fax Number	:	302-798-6672

Provider Business Practice Location Address
First Line	:	2401 PHILADELPHIA PIKE
Second Line	:
City	:	CLAYMONT
State	:	DE
Zip	:	19703-2430
Country	:	US
Telephone Number	:	302-428-4110
Fax Number	:	302-798-6672

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

Provider Enumeration Date	:	06/15/2007
Last Update Date	:	10/16/2019

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