Provider Demographics
NPI:1871002618
Name:PETER M BIRNSTEIN MD PROF CORP FAMILY PRACTICE ASSOC
Entity Type:Organization
Organization Name:PETER M BIRNSTEIN MD PROF CORP FAMILY PRACTICE ASSOC
Other - Org Name:PETER M BIRNSTEIN MD PROF FAMILY PRACTICE ASSOC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:M
Authorized Official - Last Name:BIRNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-394-2695
Mailing Address - Street 1:2811 WILSHIRE BLVD STE 800
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4808
Mailing Address - Country:US
Mailing Address - Phone:310-453-6361
Mailing Address - Fax:310-393-0245
Practice Address - Street 1:2811 WILSHIRE BLVD STE 800
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4808
Practice Address - Country:US
Practice Address - Phone:310-453-6361
Practice Address - Fax:310-393-0245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22732207QA0505X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty