Provider Demographics
NPI:1265435473
Name:BIRD, RICHARD EARL (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:EARL
Last Name:BIRD
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 1:560 RIVERSIDE DR
Mailing Address - Street 2:SUITE B204
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-4700
Mailing Address - Country:US
Mailing Address - Phone:410-546-5722
Mailing Address - Fax:
Practice Address - Street 1:560 RIVERSIDE DRIVE
Practice Address - Street 2:SUITE B204
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801
Practice Address - Country:US
Practice Address - Phone:410-546-5722
Practice Address - Fax:410-546-5851
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0022132174400000X
PAMD4589902084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD76344Medicare UPIN
MDH251G993Medicare ID - Type Unspecified