Provider Demographics
NPI:1417919861
Name:DAVID BIRCH D.O.
Entity Type:Organization
Organization Name:DAVID BIRCH D.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRCH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:302-644-0714
Mailing Address - Street 1:1602 NEWPORT GAP PIKE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-6208
Mailing Address - Country:US
Mailing Address - Phone:302-633-5740
Mailing Address - Fax:302-633-5844
Practice Address - Street 1:19160 COASTAL HWY
Practice Address - Street 2:UNIT A
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-6110
Practice Address - Country:US
Practice Address - Phone:302-644-0714
Practice Address - Fax:302-644-0716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC20002893207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE080010983OtherPALMETTO GBA