MEDICARE: DR. CHARLES F IRWIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	0101027771	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080188105	OTHER	VA	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	292417	OTHER	VA	ANTHEM

General Provider Information

NPI Number	:	1639141039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES F IRWIN M.D.

Provider Business Mailing Address
First Line	:	7229 FOREST AVE
Second Line	:	SUITE 208
City	:	RICHMOND
State	:	VA
Zip	:	23226-3765
Country	:	US
Telephone Number	:	804-281-0271
Fax Number	:	804-521-9367

Provider Business Practice Location Address
First Line	:	10431 PATTERSON AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23238-5101
Country	:	US
Telephone Number	:	804-741-6200
Fax Number	:	804-741-6213

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	11/25/2009

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Directions to “ DR. CHARLES F IRWIN M.D.” Practice Location

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