Provider Demographics
NPI:1114072519
Name:BIRD, ANTONIO MODESTO (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:MODESTO
Last Name:BIRD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14 S PACK SQ
Mailing Address - Street 2:SUITE 362
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-3511
Mailing Address - Country:US
Mailing Address - Phone:828-232-1994
Mailing Address - Fax:828-232-9941
Practice Address - Street 1:14 S PACK SQ
Practice Address - Street 2:SUITE 362
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3511
Practice Address - Country:US
Practice Address - Phone:828-232-1994
Practice Address - Fax:828-232-9941
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95014942084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G39699Medicare UPIN