Provider Demographics
NPI:1356415764
Name:NOVELLE D T KIRWAN MD PA
Entity type:Organization
Organization Name:NOVELLE D T KIRWAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NOVELLE
Authorized Official - Middle Name:D T
Authorized Official - Last Name:KIRWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-681-0282
Mailing Address - Street 1:PO BOX 151167
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33684-1167
Mailing Address - Country:US
Mailing Address - Phone:813-681-0282
Mailing Address - Fax:813-936-9318
Practice Address - Street 1:4801 N HOWARD AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1411
Practice Address - Country:US
Practice Address - Phone:813-681-0282
Practice Address - Fax:813-936-9318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD54062Medicare UPIN