Provider Demographics
NPI:1528113925
Name:ANTONIO M BIRD MD PA
Entity type:Organization
Organization Name:ANTONIO M BIRD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:MODESTO
Authorized Official - Last Name:BIRD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-232-1994
Mailing Address - Street 1:14 S PACK SQ
Mailing Address - Street 2:SUITE 362
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-3511
Mailing Address - Country:US
Mailing Address - Phone:828-232-1994
Mailing Address - Fax:828-232-9941
Practice Address - Street 1:14 S PACK SQ
Practice Address - Street 2:SUITE 362
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3511
Practice Address - Country:US
Practice Address - Phone:828-232-1994
Practice Address - Fax:828-232-9941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95014942084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2233101AMedicare ID - Type Unspecified