Provider Demographics
NPI:1972637718
Name:IRVIN, NATALIE RACHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:RACHELLE
Last Name:IRVIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11454 WHITETAIL DR
Mailing Address - Street 2:
Mailing Address - City:DOSWELL
Mailing Address - State:VA
Mailing Address - Zip Code:23047-1727
Mailing Address - Country:US
Mailing Address - Phone:701-630-1210
Mailing Address - Fax:
Practice Address - Street 1:11454 WHITETAIL DR
Practice Address - Street 2:
Practice Address - City:DOSWELL
Practice Address - State:VA
Practice Address - Zip Code:23047-1727
Practice Address - Country:US
Practice Address - Phone:701-630-1210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA97510207Q00000X
VA0101102508207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND16124Medicaid
NDN716909Medicare PIN
003551D11Medicare ID - Type Unspecified
ND16124Medicaid
NDN716908Medicare PIN