Provider Demographics
NPI:1205199874
Name:BIRKETT, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:BIRKETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CUMMINGS CTR STE 112D
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6105
Mailing Address - Country:US
Mailing Address - Phone:978-922-9226
Mailing Address - Fax:410-706-6976
Practice Address - Street 1:100 CUMMINGS CTR STE 112D
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6105
Practice Address - Country:US
Practice Address - Phone:978-922-9226
Practice Address - Fax:410-706-6976
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD856112086X0206X
MA252467390200000X
PAMT214631208C00000X
MA271766208C00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery