Provider Demographics
NPI:1255485918
Name:IRVING, HARRY (DO)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:
Last Name:IRVING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-0468
Mailing Address - Country:US
Mailing Address - Phone:207-858-8367
Mailing Address - Fax:207-474-9261
Practice Address - Street 1:46 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-1481
Practice Address - Country:US
Practice Address - Phone:207-474-5121
Practice Address - Fax:207-474-3441
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO1316207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1255485918Medicaid
MEE73983OtherANTHEM
MEE73983Medicare UPIN
MEMM5171Medicare ID - Type UnspecifiedMEDICARE