Provider Demographics
NPI:1245216506
Name:IRWIN, CATHERINE LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:LOUISE
Last Name:IRWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CATHERINE
Other - Middle Name:LOUISE
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4001 DALE ST
Mailing Address - Street 2:#213
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5428
Mailing Address - Country:US
Mailing Address - Phone:907-562-2944
Mailing Address - Fax:907-562-6321
Practice Address - Street 1:4001 DALE ST
Practice Address - Street 2:#213
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5428
Practice Address - Country:US
Practice Address - Phone:907-562-2944
Practice Address - Fax:907-562-6321
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3491208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD0938Medicaid
B59651Medicare UPIN