Provider Demographics
NPI:1992079404
Name:GILBERT R. IRWIN, M.D.P.C
Entity type:Organization
Organization Name:GILBERT R. IRWIN, M.D.P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:JANOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-361-5116
Mailing Address - Street 1:9590 SURVEYOR COURT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4406
Mailing Address - Country:US
Mailing Address - Phone:703-361-5116
Mailing Address - Fax:703-361-5876
Practice Address - Street 1:9590 SURVEYOR COURT
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4406
Practice Address - Country:US
Practice Address - Phone:703-361-5116
Practice Address - Fax:703-361-5876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101023931305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA112930048Medicare PIN