Provider Demographics
NPI:1033592902
Name:BIRD, HECTOR DAVID (PA-C)
Entity Type:Individual
Prefix:MR
First Name:HECTOR
Middle Name:DAVID
Last Name:BIRD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 KIDWELL DR STE 101
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3930
Mailing Address - Country:US
Mailing Address - Phone:571-348-4721
Mailing Address - Fax:
Practice Address - Street 1:1951 KIDWELL DR STE 101
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3930
Practice Address - Country:US
Practice Address - Phone:571-348-4721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9110058363A00000X
VA0110009304363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant