Provider Demographics
NPI:1598186637
Name:BIRD, ALAN
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:BIRD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W CHELTEN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-3301
Mailing Address - Country:US
Mailing Address - Phone:215-843-2020
Mailing Address - Fax:215-843-7428
Practice Address - Street 1:101 W CHELTEN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-3301
Practice Address - Country:US
Practice Address - Phone:215-843-2020
Practice Address - Fax:215-843-7428
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-16
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization