Provider Demographics
NPI:1386613339
Name:IRLANDEZ, DIOSDADO M (MD)
Entity type:Individual
Prefix:DR
First Name:DIOSDADO
Middle Name:M
Last Name:IRLANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:55 WHITCHER ST NE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1155
Mailing Address - Country:US
Mailing Address - Phone:770-424-6893
Mailing Address - Fax:770-528-9938
Practice Address - Street 1:55 WHITCHER ST NE
Practice Address - Street 2:SUITE 350
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1155
Practice Address - Country:US
Practice Address - Phone:770-424-6893
Practice Address - Fax:770-528-9938
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2019-12-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA54750207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA167157268FMedicaid
GA167157268HMedicaid
GA167157268IMedicaid
GA167157268JMedicaid
GA167157268GMedicaid
GA167157268HMedicaid
GA167157268IMedicaid