Provider Demographics
NPI:1225033863
Name:IRWIN, JESSE J (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:J
Last Name:IRWIN
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 1:3928 BENTON ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-1783
Mailing Address - Country:US
Mailing Address - Phone:202-337-6868
Mailing Address - Fax:
Practice Address - Street 1:2300 E ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20372-0001
Practice Address - Country:US
Practice Address - Phone:202-762-0553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233258208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00725989Medicare PIN
DC156837YR9Medicare PIN
MD151876Y1ZMedicare PIN