Provider Demographics
NPI:1407144967
Name:BIRD, JANICE C (PA)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:C
Last Name:BIRD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 E BUTLER PIKE
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2310
Mailing Address - Country:US
Mailing Address - Phone:215-643-7800
Mailing Address - Fax:215-654-1256
Practice Address - Street 1:722 E BUTLER PIKE
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-2310
Practice Address - Country:US
Practice Address - Phone:215-643-7800
Practice Address - Fax:215-654-1256
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003167L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical