Provider Demographics
NPI:1255376752
Name:IRUELA, MARIA EUGENIA (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:EUGENIA
Last Name:IRUELA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2085 FRONTIS PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5614
Practice Address - Country:US
Practice Address - Phone:336-481-8655
Practice Address - Fax:336-277-9165
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29757207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC080170773OtherRAIL ROAD MEDICARE
NC8945339Medicaid
NC45339OtherBCBSNC
NC01-08776OtherUNITED HEALTHCARE
NC22839OtherPARTNERS
NC2159319CMedicare PIN