Provider Demographics
NPI:1790779205
Name:IRVIN, HEATHER M (MD)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:M
Last Name:IRVIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 ANN ST
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-5122
Mailing Address - Country:US
Mailing Address - Phone:304-865-5065
Mailing Address - Fax:304-865-5036
Practice Address - Street 1:604 ANN ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5122
Practice Address - Country:US
Practice Address - Phone:304-865-5065
Practice Address - Fax:304-865-5036
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21425207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000216Medicaid
WV4132061Medicare PIN
WVI06020Medicare UPIN