Provider Demographics
NPI:1659422699
Name:CHARLES A. BIRBARA, M.D.
Entity Type:Organization
Organization Name:CHARLES A. BIRBARA, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BIRBARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-799-2674
Mailing Address - Street 1:25 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2751
Mailing Address - Country:US
Mailing Address - Phone:508-799-2674
Mailing Address - Fax:508-799-2586
Practice Address - Street 1:25 OAK AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2751
Practice Address - Country:US
Practice Address - Phone:508-799-2674
Practice Address - Fax:508-799-2586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM11203Medicare PIN
MAA67226Medicare UPIN