Provider Demographics
NPI:1043475502
Name:IRWIN A BUCHWALD MD PC
Entity Type:Organization
Organization Name:IRWIN A BUCHWALD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IRWIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUCHWALD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-934-8319
Mailing Address - Street 1:6 LANCASTER COUNTY ROAD
Mailing Address - Street 2:SUITE #6
Mailing Address - City:HARVARD
Mailing Address - State:MA
Mailing Address - Zip Code:01451
Mailing Address - Country:US
Mailing Address - Phone:800-675-9596
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852
Practice Address - Country:US
Practice Address - Phone:800-675-9596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA35122207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
M13064OtherBLUE SHIELD OF MA