Provider Demographics
NPI:1154525145
Name:THOMAS IRVINE, MD, PC
Entity type:Organization
Organization Name:THOMAS IRVINE, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:508-548-2402
Mailing Address - Street 1:10 BRAMBLE BUSH DR
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2325
Mailing Address - Country:US
Mailing Address - Phone:508-548-2402
Mailing Address - Fax:508-540-2235
Practice Address - Street 1:90 TER HEUN DR
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2533
Practice Address - Country:US
Practice Address - Phone:508-548-2402
Practice Address - Fax:508-540-2235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAIRM18568OtherBLUE CROSS BLUE SHIELD GR
MAA20563Medicare ID - Type Unspecified