Provider Demographics
NPI:1720202658
Name:BIRD, JOANNA M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:M
Last Name:BIRD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2343
Mailing Address - Country:US
Mailing Address - Phone:973-822-0222
Mailing Address - Fax:973-822-0225
Practice Address - Street 1:10 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2343
Practice Address - Country:US
Practice Address - Phone:973-822-0222
Practice Address - Fax:973-822-0225
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2302412084P0800X, 2084P0804X
NJ25MA086572002084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
692BM1Medicare PIN