Provider Demographics
NPI:1508950122
Name:IRIZARRY CLAUDIO, ELIUD (MD)
Entity Type:Individual
Prefix:
First Name:ELIUD
Middle Name:
Last Name:IRIZARRY CLAUDIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ELIUD
Other - Middle Name:
Other - Last Name:IRIZARRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:213 S JEFFERSON ST STE 625
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5516
Mailing Address - Fax:540-224-5684
Practice Address - Street 1:3 RIVERSIDE CIR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4955
Practice Address - Country:US
Practice Address - Phone:540-224-5170
Practice Address - Fax:540-985-9427
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0164462084N0008X, 2084N0400X
VA01012710552084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01616094OtherRR MEDICARE
IN000000789640OtherANTHEM BCBS
IN000000885703OtherANTHEM BCBS
IN201120720Medicaid
IN236040020Medicare PIN