Provider Demographics
NPI:1679512511
Name:BIRNBERG, RICHARD DANIEL (MD04)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:DANIEL
Last Name:BIRNBERG
Suffix:
Gender:M
Credentials:MD04
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10910 GRANDE BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33412-1334
Mailing Address - Country:US
Mailing Address - Phone:561-622-8596
Mailing Address - Fax:561-514-5540
Practice Address - Street 1:1150 45TH ST
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2361
Practice Address - Country:US
Practice Address - Phone:561-514-5302
Practice Address - Fax:561-514-5540
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60761207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374218100Medicaid
FL374218100Medicaid
23708Medicare ID - Type Unspecified