Provider Demographics
NPI:1235142613
Name:BIRDSALL, MARIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:
Last Name:BIRDSALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 LENNON LN STE 203
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2483
Mailing Address - Country:US
Mailing Address - Phone:925-939-7334
Mailing Address - Fax:925-939-7340
Practice Address - Street 1:301 LENNON LN STE 203
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2483
Practice Address - Country:US
Practice Address - Phone:925-939-7334
Practice Address - Fax:925-939-7340
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55509208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics