Provider Demographics
NPI:1760457220
Name:KIRWAN, NOVELLE DT (MD)
Entity Type:Individual
Prefix:
First Name:NOVELLE
Middle Name:DT
Last Name:KIRWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4801 N HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-1411
Mailing Address - Country:US
Mailing Address - Phone:727-210-1373
Mailing Address - Fax:727-210-1384
Practice Address - Street 1:4801 N HOWARD AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1411
Practice Address - Country:US
Practice Address - Phone:813-681-0282
Practice Address - Fax:813-936-9318
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0039192208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD54062Medicare UPIN