Basic Information
Provider Information
NPI: 1497950927
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BIRD
FirstName: COLIN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 602373
Address2:  
City: CHARLOTTE
State: NC
PostalCode: 282602373
CountryCode: US
TelephoneNumber: 8282131500
FaxNumber: 8286516570
Practice Location
Address1: 14 MEDICAL PARK DR
Address2:  
City: ASHEVILLE
State: NC
PostalCode: 288032493
CountryCode: US
TelephoneNumber: 8282523366
FaxNumber: 8282580891
Other Information
ProviderEnumerationDate: 06/15/2007
LastUpdateDate: 09/13/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000X2014-01151NCY Allopathic & Osteopathic PhysiciansSurgery 

No ID Information.


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