Provider Demographics
NPI:1831328749
Name:IRVIN, RISHA RENEE' (MD)
Entity type:Individual
Prefix:DR
First Name:RISHA
Middle Name:RENEE'
Last Name:IRVIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:RISHA
Other - Middle Name:RENEE'
Other - Last Name:IRBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:725 N WOLFE ST
Mailing Address - Street 2:SUITE 218A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21205-2105
Mailing Address - Country:US
Mailing Address - Phone:443-287-4843
Mailing Address - Fax:
Practice Address - Street 1:725 N WOLFE ST
Practice Address - Street 2:SUITE 218A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-2105
Practice Address - Country:US
Practice Address - Phone:443-287-4843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD77773207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine