Provider Demographics
NPI:1578565180
Name:IRWIN-SCOTT, VIRGINIA (DO)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:IRWIN-SCOTT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 JOHN SINGER SARGENT WAY
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-7213
Mailing Address - Country:US
Mailing Address - Phone:568-374-4440
Mailing Address - Fax:
Practice Address - Street 1:129 JOHNSON RD
Practice Address - Street 2:SUITE 4
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-1777
Practice Address - Country:US
Practice Address - Phone:856-374-4440
Practice Address - Fax:856-374-4445
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06117000207R00000X
NJ25MB06117000207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6868509Medicaid
NJ783550OtherMEDICARE ID-TYPE UNSPECIFIED
NJ6868509Medicaid