Provider Demographics
NPI:1508339169
Name:RICHARD A. IRVIN, DO
Entity Type:Organization
Organization Name:RICHARD A. IRVIN, DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:IRVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-242-2303
Mailing Address - Street 1:2129 NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-5264
Mailing Address - Country:US
Mailing Address - Phone:304-242-2303
Mailing Address - Fax:304-242-4231
Practice Address - Street 1:2129 NATIONAL RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-5264
Practice Address - Country:US
Practice Address - Phone:304-242-2303
Practice Address - Fax:304-242-4231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0053352001Medicaid
OH2310412Medicaid