Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 0101243536 | VA |
NPI | 1063685121 |
---|---|
Provider Name | Amy J Irwin |
First Address | Reston, VA 20190-5901 |
Second Address | Reston, VA 20190-5901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2008 |
Last Update Date | 23/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063685121 | (05) | VA |