Provider Demographics
NPI:1083711378
Name:IRWIN, THOMAS BERGAN (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:BERGAN
Last Name:IRWIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 STOCKBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1295
Mailing Address - Country:US
Mailing Address - Phone:413-528-8580
Mailing Address - Fax:
Practice Address - Street 1:33 NORTH ST
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:MA
Practice Address - Zip Code:01226-1202
Practice Address - Country:US
Practice Address - Phone:413-528-8580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230602207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine