Provider Demographics
NPI:1124814447
Name:BIRCH MEDICAL AND SKINCARE PLLC
Entity type:Organization
Organization Name:BIRCH MEDICAL AND SKINCARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-443-1010
Mailing Address - Street 1:650 SIERRA ROSE DR STE B
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2081
Mailing Address - Country:US
Mailing Address - Phone:775-443-1530
Mailing Address - Fax:
Practice Address - Street 1:650 SIERRA ROSE DR STE B
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2081
Practice Address - Country:US
Practice Address - Phone:775-443-1530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty