Provider Demographics
NPI:1225021603
Name:BIRD, GORDON (MD)
Entity Type:Individual
Prefix:MR
First Name:GORDON
Middle Name:
Last Name:BIRD
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 1:777 NORTH ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4147
Mailing Address - Country:US
Mailing Address - Phone:413-499-8510
Mailing Address - Fax:
Practice Address - Street 1:777 NORTH ST
Practice Address - Street 2:SUITE 207
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4147
Practice Address - Country:US
Practice Address - Phone:413-499-8510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA37611207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAI22210OtherBCBS
MA000000020927OtherHEALTHNET
MA759786OtherTUFTS
MA0150444Medicaid
MA110212054OtherRAILROAD MEDICARE
MAA55970OtherHARVARD
MA10641OtherHEALTH NEW ENGLAND
MA043531502OtherCIGNA INDEMNITY
MA387192OtherCIGNA/HEALTHSOURCE
MA10034386OtherCAPITAL PHYSICIANS HEALTH
MA043531502OtherGIC INDEMNITY
MA043531502OtherHMC PPO
MA346297OtherMVP
MA10034386OtherCAPITAL PHYSICIANS HEALTH
MA759786OtherTUFTS