Provider Demographics
NPI:1760418073
Name:BIRNBAUM, KATHLEEN A (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:A
Last Name:BIRNBAUM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2401 W BELVEDERE AVE
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5216
Mailing Address - Country:US
Mailing Address - Phone:410-601-5524
Mailing Address - Fax:410-601-8946
Practice Address - Street 1:5051 GREENSPRING AVENUE
Practice Address - Street 2:MICHEL MIROWSKI, MD, OFF. BLDG
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209
Practice Address - Country:US
Practice Address - Phone:410-601-9515
Practice Address - Fax:410-601-8095
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC01147363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQ70024Medicare UPIN
MDS576Medicare PIN
MDS576O040Medicare PIN
MD185867Y4HMedicare PIN