Provider Demographics
NPI:1952405292
Name:IBARRA, IRENE F (MD, PA)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:F
Last Name:IBARRA
Suffix:
Gender:F
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 S HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-2348
Mailing Address - Country:US
Mailing Address - Phone:410-327-5000
Mailing Address - Fax:410-327-5103
Practice Address - Street 1:261 S HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2348
Practice Address - Country:US
Practice Address - Phone:410-327-5000
Practice Address - Fax:410-327-5103
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0038033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD334MMedicare ID - Type Unspecified
MDB06926Medicare UPIN