Provider Demographics
NPI:1114929585
Name:IRIGOYEN, OSCAR HORACIO (MD)
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:HORACIO
Last Name:IRIGOYEN
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 1:1015 WALNUT ST
Mailing Address - Street 2:STE 613
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5005
Mailing Address - Country:US
Mailing Address - Phone:215-955-1415
Mailing Address - Fax:215-955-7885
Practice Address - Street 1:1015 WALNUT ST
Practice Address - Street 2:STE 613
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5005
Practice Address - Country:US
Practice Address - Phone:215-955-1415
Practice Address - Fax:215-955-7885
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146326207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00604100Medicaid
51A681Medicare ID - Type Unspecified
NY00604100Medicaid