Basic Information
| Provider Information | |||||||||
| NPI: | 1134329402 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BIRKNES | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 49 SPRING ST | ||||||||
| Address2: | |||||||||
| City: | SCARBOROUGH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040748926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078850011 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 49 SPRING ST | ||||||||
| Address2: | |||||||||
| City: | SCARBOROUGH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040748926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078850011 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2007 | ||||||||
| LastUpdateDate: | 05/28/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0120X | MD422479 | PA | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 207T00000X | MD23462 | ME | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 2086S0120X | 0101244138 | VA | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 207T00000X | 0101244138 | VA | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1134329402 | 01 | VA | OPTIMA HEALTH CARE | OTHER | 5910591 | 05 | NC | MEDICAID | 1134329402 | 01 | VA | AETNA | OTHER | 1134329402 | 01 | VA | MAMSI/OPTIMUM CHOICE | OTHER | 1134329402 | 05 | VA | MEDICAID | 364137 | 01 | VA | ANTHEM BC/BS | OTHER | 1134329402 | 01 | VA | CIGNA | OTHER | 1134329402 | 01 | VA | MDIPA | OTHER |