Provider Demographics
NPI:1184701369
Name:BIRD, CHARRELL MOYO (MD)
Entity type:Individual
Prefix:DR
First Name:CHARRELL
Middle Name:MOYO
Last Name:BIRD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHARRELL
Other - Middle Name:MOYO
Other - Last Name:BULLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-4200
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:1505 W SHERMAN AVE
Practice Address - Street 2:PEDIATRIX MEDICAL GROUP
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-7059
Practice Address - Country:US
Practice Address - Phone:856-845-0100
Practice Address - Fax:302-651-4945
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4243092080N0001X
NJ25MA093874002080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018646620001Medicaid