Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD24228 | ME |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 19947 | NH |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 275087 | MA |
NPI | 1104263565 |
---|---|
Provider Name | Dr. Craig Munro Birch |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2013 |
Last Update Date | 03/02/2021 |