Provider Demographics
NPI:1649305756
Name:IRWIN, DAVID S (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:IRWIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 TOWER OAKS BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852
Mailing Address - Country:US
Mailing Address - Phone:240-200-5401
Mailing Address - Fax:240-558-3592
Practice Address - Street 1:3204 TOWER OAKS BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852
Practice Address - Country:US
Practice Address - Phone:240-200-5401
Practice Address - Fax:240-558-3592
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00017142084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
52-1133831OtherFEDERAL TAX ID
28564OtherMAMSI PROVIDER #
621812Medicare ID - Type UnspecifiedMEDICARE PROVIDER #