Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 0101244138 | VA |
N | 207T00000X | Neurosurgeon | MD23462 | ME |
N | 2086S0120X | Pediatric Surgery | 0101244138 | VA |
N | 2086S0120X | Pediatric Surgery | MD422479 | PA |
NPI | 1134329402 |
---|---|
Provider Name | John Birknes |
First Address | Scarborough, ME 04074-8926 |
Second Address | Scarborough, ME 04074-8926 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2007 |
Last Update Date | 28/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1134329402 | (05) | VA |
1134329402 | AETNA (01) | VA |
1134329402 | CIGNA (01) | VA |
1134329402 | MAMSI/OPTIMUM CHOICE (01) | VA |
1134329402 | MDIPA (01) | VA |
1134329402 | OPTIMA HEALTH CARE (01) | VA |
364137 | ANTHEM BC/BS (01) | VA |
5910591 | (05) | NC |
C06141 | (02) | VA |