Provider Demographics
NPI:1316508633
Name:IRVING, DONDRE (DO)
Entity type:Individual
Prefix:DR
First Name:DONDRE
Middle Name:
Last Name:IRVING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STONY BROOK MEDICINE HSC LEVEL 4, ROOM 176
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8430
Mailing Address - Country:US
Mailing Address - Phone:631-444-2084
Mailing Address - Fax:
Practice Address - Street 1:STONY BROOK MEDICINE HSC LEVEL 4, ROOM 176
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-4006
Practice Address - Country:US
Practice Address - Phone:631-444-2084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program