Healthcare Provider Details

I. General information

NPI: 1316470438
Provider Name (Legal Business Name): OLGA CORAZON IRIZARRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4051 FREEMANSBURG AVE
EASTON PA
18045-5596
US

IV. Provider business mailing address

4051 FREEMANSBURG AVE
EASTON PA
18045-5596
US

V. Phone/Fax

Practice location:
  • Phone: 484-503-7474
  • Fax:
Mailing address:
  • Phone: 484-503-7474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT212721
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA11160100
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD469408
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: