Provider Demographics
NPI:1851483010
Name:BIRMINGHAM, KAREN LESLEY (MD)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LESLEY
Last Name:BIRMINGHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:110 ROOSEVELT BLVD
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:MARMORA
Mailing Address - State:NJ
Mailing Address - Zip Code:08223-1403
Mailing Address - Country:US
Mailing Address - Phone:609-390-2404
Mailing Address - Fax:609-390-2644
Practice Address - Street 1:110 ROOSEVELT BLVD
Practice Address - Street 2:SUITE 2B
Practice Address - City:MARMORA
Practice Address - State:NJ
Practice Address - Zip Code:08223-1403
Practice Address - Country:US
Practice Address - Phone:609-390-2404
Practice Address - Fax:609-390-2644
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07419800208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ065219Medicare PIN
NJ065219ZEMEMedicare PIN
NJ065219V07Medicare PIN
NJH05773Medicare UPIN