Provider Demographics
NPI:1609835404
Name:BIRD, EDWARD LELAND (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:LELAND
Last Name:BIRD
Suffix:
Gender:M
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-6719
Mailing Address - Country:US
Mailing Address - Phone:410-574-0410
Mailing Address - Fax:
Practice Address - Street 1:6830 HOSPITAL DR
Practice Address - Street 2:SUITE 204
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4373
Practice Address - Country:US
Practice Address - Phone:443-559-5063
Practice Address - Fax:443-559-5078
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC01302363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S69862Medicare UPIN