Provider Demographics
NPI:1659378628
Name:BIRNBAUM, NEIL S (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:S
Last Name:BIRNBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1177 PROVIDENCE HIGHWAY, ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062
Mailing Address - Country:US
Mailing Address - Phone:781-278-5540
Mailing Address - Fax:781-762-7623
Practice Address - Street 1:1177 BOSTON PROVIDENCE TPKE
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-5019
Practice Address - Country:US
Practice Address - Phone:781-278-5540
Practice Address - Fax:781-762-7623
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2021-01-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA59486207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0016042OtherONE HEALTH PLAN
059486OtherTUFTS
65027OtherHAVARD PILGRAM
A66615OtherFIRST SENIORITY
J07346OtherHMO BLUE CHOICE
04-40796OtherUNITED HEALTHCARE PPO
3033911OtherMASS HEALTH
5970687OtherCIGNA
J07346OtherBLUE SHIELD INDEMNITY
110119266OtherRAILROAD MEDICARE
5970687OtherHEALTHSOURCE
3033911OtherMASS HEALTH
5970687OtherCIGNA