Provider Demographics
NPI:1053308478
Name:BIRNBAUM, FRED (DPM)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:
Last Name:BIRNBAUM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 STREET RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-3755
Mailing Address - Country:US
Mailing Address - Phone:215-245-0873
Mailing Address - Fax:215-245-4011
Practice Address - Street 1:1950 STREET RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-3755
Practice Address - Country:US
Practice Address - Phone:215-245-0873
Practice Address - Fax:215-245-4011
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001969L213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0844935Medicaid
PA0844935Medicaid
PA100594Medicare ID - Type Unspecified