Provider Demographics
NPI:1063985356
Name:IRBY, DONALD
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:IRBY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-3912
Mailing Address - Country:US
Mailing Address - Phone:757-287-2695
Mailing Address - Fax:
Practice Address - Street 1:445 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-3912
Practice Address - Country:US
Practice Address - Phone:757-287-2695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ59104B171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor