Individual
MARK ALLEN BIRD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
159 EXECUTIVE DR, SUITE C, DANVILLE, VA 24541-4160
(434) 792-5964
(434) 792-5971
Mailing address
159 EXECUTIVE DR, SUITE B, DANVILLE, VA 24541-4160
(434) 792-5964
(434) 792-5971
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
010123776
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010151163
—
VA
01
—
177390
ANTHEM
VA
01
—
P00223399
RAILROAD MEDICARE
VA
Enumeration date
04/07/2006
Last updated
01/10/2017
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