Basic Information
| Provider Information | |||||||||
| NPI: | 1205199874 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BIRKETT | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 CUMMINGS CTR STE 112D | ||||||||
| Address2: | |||||||||
| City: | BEVERLY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019156105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9789229226 | ||||||||
| FaxNumber: | 4107066976 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 CUMMINGS CTR STE 112D | ||||||||
| Address2: | |||||||||
| City: | BEVERLY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019156105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9789229226 | ||||||||
| FaxNumber: | 4107066976 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2012 | ||||||||
| LastUpdateDate: | 08/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086X0206X | D85611 | MD | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology | 208C00000X | MT214631 | PA | N | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 390200000X | 252467 | MA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208C00000X | 271766 | MA | Y | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
No ID Information.