Provider Demographics
NPI:1932103298
Name:BIRKBY, BRUCE E (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:E
Last Name:BIRKBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MERRIMACK ST
Mailing Address - Street 2:RIVERWALK
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1756
Mailing Address - Country:US
Mailing Address - Phone:978-557-8900
Mailing Address - Fax:978-557-8944
Practice Address - Street 1:500 MERRIMACK ST
Practice Address - Street 2:RIVERWALK
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1756
Practice Address - Country:US
Practice Address - Phone:978-557-8900
Practice Address - Fax:978-557-8944
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2008-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA49426207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30004117OtherNH MEDICAID
MA3066533Medicaid
NVA66532OtherANTHEM BLUE CROSS
4374789OtherAETNA - NON-HMO
67889OtherHEALTHSOURCE
02-00098OtherEVERCARE
MA049426OtherTUFTS HEALTH PLAN
MA1216OtherHARVARD PILGRIM HEALTHCAR
1932103298OtherAETNA - HMO
6287992OtherCIGNA HEALTHCARE
MAJ06948OtherBLUE CROSS BLUE SHIELD
030004806OtherRAILROAD MEDICARE
978456OtherNETWORK HEALTH
0012018OtherNEIGHBORHOOD HEALTH PLAN
67889OtherHEALTHSOURCE
MAJ06948Medicare ID - Type Unspecified