Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 26045 | WV |
N | 2080P0210X | Pediatric Nephrologist | 35.056857 | OH |
N | 2080P0210X | Pediatric Nephrologist | 64589 | CT |
N | 2080P0210X | Pediatric Nephrologist | MD462830 | PA |
N | 208D00000X | General Practice Physician | 26045 | WV |
NPI | 1376547042 |
---|---|
Provider Name | Dr. Kimberly C Irwin |
First Address | Bridgeport, WV 26330-9108 |
Second Address | New Haven, CT 06510-3220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 10/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F30445 | (02) | TX |