Provider Demographics
NPI:1154477255
Name:IRWIN, BRIAN ELIAS
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:ELIAS
Last Name:IRWIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 BANYAN CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-4494
Mailing Address - Country:US
Mailing Address - Phone:717-393-2250
Mailing Address - Fax:
Practice Address - Street 1:725 SKIPPACK PIKE
Practice Address - Street 2:SUIUTE 300
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1741
Practice Address - Country:US
Practice Address - Phone:866-894-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer