Provider Demographics
NPI:1316040603
Name:BIRD, RICHARD CRANSON (MD, MPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:CRANSON
Last Name:BIRD
Suffix:
Gender:M
Credentials:MD, MPH
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:UPHAM'S CORNER HEALTH CENTER, 500 COLUMBIA ROAD
Mailing Address - Street 2:MAIL STOP 415-01
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125
Mailing Address - Country:US
Mailing Address - Phone:781-367-1245
Mailing Address - Fax:781-646-5770
Practice Address - Street 1:UPHAM'S CORNER HEALTH CENTER, 500 COLUMBIA ROAD
Practice Address - Street 2:MAIL STOP 415-01
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02125
Practice Address - Country:US
Practice Address - Phone:617-287-8000
Practice Address - Fax:617-740-8070
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA75492207R00000X, 2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3108490Medicare ID - Type UnspecifiedMASS HEALTH, MEDICAID