Provider Demographics
NPI:1497796148
Name:BIRBECK, GRETCHEN LANO (MD)
Entity Type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:LANO
Last Name:BIRBECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:L
Other - Last Name:DIKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 278984
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-1200
Mailing Address - Fax:585-756-5189
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 673
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-1200
Practice Address - Fax:585-756-5189
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2709252084N0400X
MI43010756962084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4210801Medicaid
MI4210801Medicaid
MI0C36078011Medicare PIN