Healthcare Provider Details

I. General information

NPI: 1720854532
Provider Name (Legal Business Name): ANDREW B IRVING FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2023
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 COMMUNITY PL
CROWNSVILLE MD
21032-2034
US

IV. Provider business mailing address

100 HOSPITAL RD
PRINCE FREDERICK MD
20678-4017
US

V. Phone/Fax

Practice location:
  • Phone: 415-640-9581
  • Fax:
Mailing address:
  • Phone: 410-535-4488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR153986
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: