Provider Demographics
NPI:1366866808
Name:DAVID S. IRWIN, M.D.,P.A.
Entity Type:Organization
Organization Name:DAVID S. IRWIN, M.D.,P.A.
Other - Org Name:DAVID S. IRWIN, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JASTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-840-1077
Mailing Address - Street 1:16220 FREDERICK RD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-4039
Mailing Address - Country:US
Mailing Address - Phone:301-840-1077
Mailing Address - Fax:301-948-6199
Practice Address - Street 1:16220 FREDERICK RD
Practice Address - Street 2:SUITE 308
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4039
Practice Address - Country:US
Practice Address - Phone:301-840-1077
Practice Address - Fax:301-948-6199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00017142084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC621812Medicare PIN
DCE52135Medicare UPIN