Provider Demographics
NPI:1922024124
Name:IRWIN, CRAIG W (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:W
Last Name:IRWIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 SOUTHPOINT DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-6350
Mailing Address - Country:US
Mailing Address - Phone:859-272-1928
Mailing Address - Fax:859-271-9601
Practice Address - Street 1:630 SOUTHPOINT DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-6350
Practice Address - Country:US
Practice Address - Phone:859-272-1928
Practice Address - Fax:859-271-9601
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36288207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY400501OtherMEDICARE LAB GRP
KY64026065Medicaid
KY37903705OtherMEDICAID LAB GRP
GACB5773OtherRR MEDICARE GRP
KY64026065Medicaid
H04728Medicare UPIN