Provider Demographics
NPI:1093286031
Name:IRWIN MEDICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:IRWIN MEDICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:IRWIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:814-817-2870
Mailing Address - Street 1:900 CHESTNUT STREET EXT STE A
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-2298
Mailing Address - Country:US
Mailing Address - Phone:814-817-2870
Mailing Address - Fax:814-368-8041
Practice Address - Street 1:900 CHESTNUT STREET EXT STE A
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-2298
Practice Address - Country:US
Practice Address - Phone:814-817-2870
Practice Address - Fax:814-368-8041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty