Provider Demographics
NPI:1124019823
Name:BIRNBAUM, DAVID B (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:BIRNBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3799
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-3799
Mailing Address - Country:US
Mailing Address - Phone:931-245-8182
Mailing Address - Fax:931-245-8196
Practice Address - Street 1:127 S RICHVIEW RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5220
Practice Address - Country:US
Practice Address - Phone:931-245-8182
Practice Address - Fax:931-245-8196
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2010-06-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN26686207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3092073Medicaid
TN180023507OtherRR MEDICARE
TN180023507OtherRR MEDICARE
TN3092076Medicare PIN