Provider Demographics
NPI:1437142882
Name:BIRNBAUM, NEAL SHELDON (MD)
Entity type:Individual
Prefix:DR
First Name:NEAL
Middle Name:SHELDON
Last Name:BIRNBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 CIVIC CENTER DR STE 200A
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-5233
Mailing Address - Country:US
Mailing Address - Phone:415-464-9604
Mailing Address - Fax:415-464-0171
Practice Address - Street 1:4000 CIVIC CENTER DR STE 200A
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-5233
Practice Address - Country:US
Practice Address - Phone:415-464-9604
Practice Address - Fax:415-464-0171
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC36561207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0046000Medicaid
00C365611Medicare PIN
CAA36309Medicare UPIN
CAZZZ38144ZMedicare ID - Type Unspecified