Provider Demographics
NPI:1164451423
Name:BIRD, BRIAN D (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:D
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 1:10 BRAMBLE BUSH DR
Mailing Address - Street 2:C/O ASAP MEDICAL SERVICES, LLC
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2325
Mailing Address - Country:US
Mailing Address - Phone:508-548-2402
Mailing Address - Fax:508-540-2235
Practice Address - Street 1:5 BRAMBLE BUSH DR
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2325
Practice Address - Country:US
Practice Address - Phone:508-548-9324
Practice Address - Fax:508-548-5239
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA516363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S01256Medicare UPIN
AP0244Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER