Provider Demographics
NPI:1770578544
Name:BIRCHESS, DAMIAN EDWIN (MD)
Entity type:Individual
Prefix:
First Name:DAMIAN
Middle Name:EDWIN
Last Name:BIRCHESS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5411 OLD FREDERICK RD
Mailing Address - Street 2:SUITE 18
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-2195
Mailing Address - Country:US
Mailing Address - Phone:410-788-4800
Mailing Address - Fax:410-788-6701
Practice Address - Street 1:5411 OLD FREDERICK RD
Practice Address - Street 2:SUITE 18
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-2195
Practice Address - Country:US
Practice Address - Phone:410-788-4800
Practice Address - Fax:410-788-6701
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0022114207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
R8280001OtherCAREFIRST BCBS FEDERAL/DC
0100819OtherUNITED HEALTHCARE/AMERIC
505176OtherAETNA
242408OtherMDIPA.MAMSI/OPTIMUM CHOIC
1449522OtherUNITED HEALTH CARE
41101801OtherCAREFIRST BCBS
139L968AMedicare PIN
R8280001OtherCAREFIRST BCBS FEDERAL/DC