Healthcare Provider Details

I. General information

NPI: 1720298599
Provider Name (Legal Business Name): SARA R IRVIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 W BROAD ST
NEWTON FALLS OH
44444-1643
US

IV. Provider business mailing address

43 W BROAD ST
NEWTON FALLS OH
44444-1643
US

V. Phone/Fax

Practice location:
  • Phone: 330-235-7445
  • Fax: 216-201-8034
Mailing address:
  • Phone: 330-235-7445
  • Fax: 216-201-8034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.088876
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: