Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 402 | MA |
N | 103T00000X | Psychologist | 402 | MA |
N | 103TH0100X | Health Service | 402 | MA |
NPI | 1174604979 |
---|---|
Provider Name | Dr. Morton Paul Birnbaum |
First Address | Sudbury, MA 01776-2408 |
Second Address | Sudbury, MA 01776-3014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
W01579 | BLUE CROSS/BLUE SHIELD (01) | MA |